Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
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Year : 2011  |  Volume : 6  |  Issue : 1  |  Page : 43-45
An elderly man with pulmonary hypertension

Department of Cardiology, Royal Hospital, Muscat - 111, Oman

Date of Submission11-Aug-2010
Date of Acceptance18-Sep-2010
Date of Web Publication28-Dec-2010

Correspondence Address:
Prashanth Panduranga
Department of Cardiology, Royal Hospital, PB 1331, Muscat - 111
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1737.74277

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How to cite this article:
Panduranga P, Mukhaini M. An elderly man with pulmonary hypertension. Ann Thorac Med 2011;6:43-5

How to cite this URL:
Panduranga P, Mukhaini M. An elderly man with pulmonary hypertension. Ann Thorac Med [serial online] 2011 [cited 2023 Feb 9];6:43-5. Available from:

A 70-year-old male, non-smoker with no past medical or surgical problems presented with two months history of worsening exertional dyspnea. He denied any history of chest pain, cough or hemoptysis. A transthoracic echocardiogram (TTE) done in a regional hospital showed a large atrial septal defect with severe pulmonary hypertension (PH) and was referred to our center for transesophageal echocardiogram (TEE) and possible device closure or surgery. Physical examination revealed a moderately built male without any distress. There was no cyanosis or clubbing. Cardiac examination revealed jugular venous pulse 4 cm above the sternal angle with prominent a-wave, right parasternal heave, loud P2, 2/6 pansystolic murmur at the left sternal border, and no pedal edema. Respiratory examination was normal. ECG showed sinus rhythm, right axis deviation and right ventricular hypertrophy. Chest radiograph was suggestive of mild cardiomegaly with no prominence of pulmonary vessels and clear lungs.

TTE and TEE were done [Figure 1] and [Figure 2].
Figure 1 :(a) Continuous wave Doppler echocardiography at tricuspid valve. (b) Transthoracic echocardiography four-chamber view

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Figure 2 :Transesophageal echocardiography in modified short-axis views. LA=Left atrium; RA=Right atrium; LV=Left ventricle

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   Questions Top

  1. What are the findings by TTE?
  2. What is seen by TEE?
  3. What is seen on computed tomography (CT) scan of chest (arrowheads)? What additional investigations are needed?
  4. What is the diagnosis in this patient?

Click here to view answer. View Answer

   References Top

1.Tapson VF, Humbert M. Incidence and prevalence of chronic thromboembolic pulmonary hypertension: From acute to chronic pulmonary embolism. Proc Am Thorac Soc 2006;3:564-7.  Back to cited text no. 1
2.Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257-64.  Back to cited text no. 2
3.Klok FA, Van Kralingen KW, van Dijk AP, Heyning FH, Vliegen HW, Huisman MV. Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. Haematologica 2010;95:970-5.  Back to cited text no. 3
4.Bonderman D, Wilkens H, Wakounig S, Schäfers HJ, Jansa P, Lindner J, et al. Risk factors for chronic thromboembolic pulmonary hypertension. Eur Respir J 2009;33:325-31.  Back to cited text no. 4
5.Castañer E, Gallardo X, Ballesteros E, Andreu M, Pallardó Y, Mata JM, et al. CT diagnosis of chronic pulmonary thromboembolism. Radiographics 2009;29:31-50.  Back to cited text no. 5
6.Rubin LJ, Hoeper MM, Klepetko W, Galiè N, Lang IM, Simonneau G. Current and future management of chronic thromboembolic pulmonary hypertension: From diagnosis to treatment responses. Proc Am Thorac Soc 2006;3:601-7.  Back to cited text no. 6
7.Lang IM, Klepetko W. Chronic thromboembolic pulmonary hypertension: an updated review. Curr Opin Cardiol 2008;23:555-9.  Back to cited text no. 7
8.Condliffe R, Kiely DG, Gibbs JS, Corris PA, Peacock AJ, Jenkins DP, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2008;177:1122-7.  Back to cited text no. 8


  [Figure 1], [Figure 2], [Figure 3]


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