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Pulmonary Arterial Hypertension in a Patient With a Lung Mass: Any Link?
Abdullah M Alharbi1,2, Mohammed S Alqarni2,3, Abdulkareem A Alkahtani4,5
1Pulmonology, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU.
Abstract:
A 52-year-old female patient with a history of atrial septal defect repair presented with progressive dyspnea and echocardiographic findings suggestive of pulmonary hypertension (PH). Incidentally, a lung mass was discovered on computed tomography (CT). Initial evaluation revealed World Health Organization functional class III symptoms and significant weight loss. Diagnostic workup included echocardiography, pulmonary function tests, CT chest, computed tomography pulmonary angiography, right heart catheterization, and positron emission tomography. Supraclavicular lymph node biopsy confirmed adenocarcinoma of pulmonary origin with positive epidermal growth factor receptor (EGFR) mutation. Right heart catheterization demonstrated vasoreactive pre-capillary PAH. The patient was initiated on nifedipine, which was gradually titrated. Subsequent ventilation-perfusion scan revealed chronic thromboembolic pulmonary hypertension (CTEPH), leading to anticoagulation therapy. We are reporting this case of PAH which presented with features of Group 4 PH and had a sarcoid-like reaction.
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