A CASE OF CHRONIC PULMONARY EMBOLISM WITH SEVERE PULMONARY HYPERTENSION IN AN ELDERLY PATIENT

A 76-year-old female was admitted to our hospital because of dyspnea on effort. She had suffered from hypertension for nine years and had a sudden onset of dyspnea a year and five months before admission. A chest reontgenogram showed marked enlargement of the cardiac shlhouette. Chest enhanced CT study revealed that an embolism in the right main pulmonary artery had caused stenosis. However, pulmonary angiographic study suggested that embolism was questionable. The pulmonary arterial pressure was 100 /30 mmHg and the right ventricular pressure was 112/10 mmHg Lung scan test showed mismatched defects between abnormal perfusion scanning and normal ventilation scanning. Venous ultrasound imaging revealed thrombosis in the popliteal vein. The patient was diagnosed as having chronic pulmonary embolism due to deep vein thrombosis. She had been taking warfarin as anticoagulant thrapy. We believe this was a case of chronic pulmonary embolism. In elderly patients with sudden onset of dyspnea, chest enhanced CT study is necessary for the accurate diagnosis of chronic pulmonary embolism