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Thursday, 28 November 2013

Pulmonary vascular disease – Pulmonary veno-occlusive disease – The Misdiagnosis

Pulmonary veno-occlusive disease
Pulmonary veno-occlusive disease (PVOD) is an extremely rare form of pulmonary hypertension, affecting mostly in children and young adults as a result of a progressive obstruction of small pulmonary veins that leads to elevation in pulmonary vascular resistance and right ventricular failure.
A. Misdiagnosis
PVOD is an underdiagnosed and commonly misdiagnosed cause of pulmonary hypertension, which may present with a failure to respond to medical therapy. Further studies on PVOD may help confirm whether a change in its classification as a type of PAH is necessary(29). Other study reported a case of a 27-yr-old female with a 6-month diagnosis of idiopathic pulmonary arterial hypertension (PAH) confirmed elsewhere was referred to our centre with worsening dyspnoea. On examination, the patient had low systemic oxygen saturation despite high oxygen flow and reduced exercise capacity. Haemodynamics were indicative of severe pre-capillary PAH. High-resolution computed tomography revealed diffuse ground-glass opacity with thickening interlobular septa, and haemosiderin-laden macrophages were identified by bronchoalveolar lavage. Based on clinical and diagnostic findings, the patient was re-diagnosed with pulmonary veno-occlusive disease (PVOD)(30). Also, there is a review of cases of 14 patients with clinically diagnosed PAH who had failed to respond to medical therapy and had lung tissue available from autopsy or explant. Control samples (n = 6) were obtained from lungs explanted for other causes, and a previous transthoracic echocardiogram excluded pulmonary hypertension(31).
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Sources
(29) http://www.ncbi.nlm.nih.gov/pubmed/19188548
(30) http://www.ncbi.nlm.nih.gov/pubmed/20956140
(31) http://www.ncbi.nlm.nih.gov/pubmed/19188548