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05 February 2019 : Case report  Germany

Diagnostic Work-Up of Pulmonary Hypertension – Think About Shunt Flow! A Case Report

Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents

Lena Hinrichs1BCDEF, Michael Horacek1CDF, Ulrich Neudorf2BDE, Thomas Schlosser3BCE, Tienush Rassaf1CDF, Matthias Totzeck1ABCDEF*

DOI: 10.12659/AJCR.912191

Am J Case Rep 2019; 20:154-158

Abstract

BACKGROUND: The diagnostic work-up and treatment of pulmonary hypertension can be complex. Pulmonary arterial hypertension (PAH), pulmonary hypertension second to lung or heart diseases and thromboembolic pulmonary hypertension, and other rare causes of pulmonary hypertension such as congenital heart diseases must be considered in the differential diagnostic work-up.

CASE REPORT: We report on a patient who has been treated for PAH over many years. At the age of 65, progressive symptoms required a complete re-evaluation. Here, a complex shunt vitium with a partial anomalous pulmonary venous return (PAPVR) and a sinus venosus defect (SVD) was diagnosed.

CONCLUSIONS: PAPVR is a rare congenital heart disease that is often associated with an SVD. It is usually diagnosed during childhood but may also be detected in adult patients who develop pulmonary hypertension and dyspnea as primary symptoms. The initial predominant left-to-right shunting associated with this disease may be undetected for years, with a slow development of right heart failure with right heart volume overload and pulmonary hypertension. Early detection is important, with a subsequent surgical intervention.

Keywords: Heart Defects, Congenital, Hypertension, Pulmonary, Scimitar Syndrome, Aged, Dyspnea

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923