1. Right heart and pulmonary thromboembolism from extensive splanchnic vein thrombosis after splenectomy for myeloproliferative disease
- Author
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Matteo Sofia, Mauro Maniscalco, Gaetano Rea, Emanuela Carpentieri, Sergio Padula, and Anna Agnese Stanziola
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart Diseases ,Perfusion Imaging ,medicine.medical_treatment ,Splenectomy ,Critical Care and Intensive Care Medicine ,Thrombophilia ,Chronic liver disease ,Severity of Illness Index ,Diagnosis, Differential ,Polycythemia vera ,Internal medicine ,medicine ,Humans ,Heart Atria ,Splanchnic Circulation ,Venous Thrombosis ,Myeloproliferative Disorders ,Thrombocytosis ,business.industry ,Thrombosis ,medicine.disease ,Surgery ,Pulmonary embolism ,Splanchnic vein thrombosis ,Hematologic disease ,Echocardiography ,Cardiology ,Female ,Pulmonary Embolism ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Splenectomy is a risk factor for both portal-vein and chronic thromboembolic pulmonary hypertension. The underlying mechanism is unclear, but may involve a hypercoagulable state. Methods We describe 1 patient with polycythemia vera who developed extensive portal thrombosis of the portal, suprahepatic, and inferior cava veins, leading to right heart thromboembolism, with a resultant pulmonary embolism subsequent to splenectomy despite heparin prophylaxis. Results In this patient, several mechanisms may have played a role, including perioperative stress, thrombocytosis, thrombophilia, and associated chronic liver disease. Nevertheless, combined treatment with intravenous heparin and thrombolysis and the myeloproliferative inhibitor hydroxyurea was associated with a favorable outcome. Conclusion The risk of pulmonary thromboembolic complications and their management after splenectomies for hematologic disease warrant further study.
- Published
- 2012
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