Navigating Diagnostic Challenges: Severe Pulmonary Hypertension in Acute Exacerbation of Chronic Obstructive Pulmonary Disease vs. Pulmonary Embolism

A 63-year-old male with an unremarkable medical history presented to the emergency room (ER) with shortness of breath and bilateral lower extremity edema. In the ER, he was found to be hypoxic and hypercapnic on an arterial blood gas. CT angiography of the chest revealed severe emphysematous changes...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-03, Vol.16 (3), p.e56907
Main Authors: Abdulfattah, Ammar, John, Sabu
Format: Article
Language:English
Subjects:
Bronchodilators
Cardiac arrhythmia
Cardiology
Chronic obstructive pulmonary disease
Cor pulmonale
Doppler effect
Electrocardiography
Emergency Medicine
Heart
Hypertension
Hypoxia
Internal Medicine
Lungs
Medical diagnosis
Medical imaging
Patients
Peptides
Pulmonary arteries
Pulmonary embolisms
Respiratory failure
Ultrasonic imaging
Veins & arteries
Velocity
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Summary:A 63-year-old male with an unremarkable medical history presented to the emergency room (ER) with shortness of breath and bilateral lower extremity edema. In the ER, he was found to be hypoxic and hypercapnic on an arterial blood gas. CT angiography of the chest revealed severe emphysematous changes and large right apical bullae. A bedside point-of-care ultrasound demonstrated many bilateral B-lines as well as normal ejection fraction (EF). An echocardiogram revealed a small left ventricular cavity with an EF of 65%, severely dilated right ventricle, severe right ventricular dysfunction, "D" shaped interventricular septum, severely dilated right atrium, and severe pulmonary arterial hypertension (PAH) with a calculated pulmonary artery systolic pressure of 72 mmHg. The patient was initiated on bilevel positive airway pressure, glucocorticoids, bronchodilator nebulization, and diuretics with symptomatic improvement. Herein, this case report discusses similarities and differences between presentations and echocardiographic manifestations of severe PAH in the setting of acute exacerbation of chronic obstructive pulmonary disease and pulmonary embolism in the acute setting.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.56907