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CTEPH (a thread)

One of the best learning cases of my residency training at Temple with @PForfiaPHDOC , I recently presented this case at a CTCV conference.

HPI: female pt in her 40s, hx recurrent PE/DVT, IVC filter, on anticoagulation, presents with SOB.
short axis view with PW of the RVOT shows mid systolic notching
@PForfiaPHDOC with high suspicion for CTEPH, checks VQ
PA gram
PA gram
But wait... CT scan also shows massive fibroid
IVC filter, pancaked by large fibroid
Decision is made to postpone GYN surgery until after patient is stabilized from a CV standpoint. Patient then goes for PTE.
Pre and Post PTE hemos were incredible
S/P PTE: Impressive improvement in RV
Repeat TTE shows that Mid Systolic Notch is gone
Patient goes to surgery with GYN for fibroid- repeat venogram s/p TAH and PTE shows... voila!
And post PTE... remarkable perfusion restored.
Excellent work @PForfiaPHDOC and PH team, the patient had no further PE or DVT. This was then published in an outstanding case series...
A must read 👩🏼‍⚕️ncbi.nlm.nih.gov/pmc/articles/P…
Next time you see CTEPH in a female pt- could the patient have fibroids causing compression of the IVC and from there showering chronic thrombus too? #cardiotwitter #pulmhtn #cteph #accfit
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