A case of chronic thromboembolic pulmonary hypertension complicated with chronic obstructive pulmonary disease and had difficulty in diagnosing

Abstract

A 72-year-old woman with chronic obstructive pulmonary disease (COPD) was admitted to our hospital because she showed hemoptysis and revealed heart failure and anemia by family doctor examination. She was suspected of severe pulmonary hypertension by echocardiography, and chest computed tomography (CT) disclosed a mosaic pattern and air trapping. However, we were unable to determine the cause of her pulmonary hypertension, and she was transferred to the university hospital. There she was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) by contrast-enhanced CT, right cardiac catheterization, and pulmonary ventilation and perfusion scintigraphy. We suggest that pulmonary hypertension out of proportion to the COPD stage, as well as a mosaic pattern on CT, may be a sign of CTEPH.