Pulmonary Hypertension Due to Chronic Thromboembolic Disease Complicated with Hemoptysis and Infection

A 45 year old woman developed exertional dyspnea after surgical removal of uterine fibroids. Heart ultrasound suggested the presence of right heart enlargement and stress due to pulmonary arterial hypertension, whereas the subsequent CT angiography revealed pulmonary embolism. Anticoagulants were initiated. Perfusion defects were noticeable in lung perfusion scan 6 months after the initiation of anticoagulant therapy, while CT angiography was negative for pulmonary embolism. The diagnosis of chronic thromboembolic pulmonary hypertension was initially set and subsequently confirmed by right heart catheterization. Deterioration of dyspnea and right heart dysfunction led to administration of intravenous epoprostenol through a tunneled central venous catheter. After 6 months the patient was admitted to the intensive care unit with fever, hemoptysis, lung infiltrates, and acute-on-chronic hypoxemic respiratory failure. Bronchial artery embolization, oxygen therapy, and antibiotics led to clinical improvement.