An unusual case of pulmonary hypertension with multiple osteosclerotic lesions

Abstract

A 47-year-old married woman with underlying sensorimotor polyneuropathy presented to our emergency department with a 2-week history of fatigue, legs edema and exertional dyspnea. On physical examination, elevated jugular vein pressure, a grade III pansystolic murmur at the left lower sternal border and peripheral edema were noted. Chest radiography revealed cardiomegaly, enlargement of the central pulmonary vessels and bilateral pleural effusions (Figure 1). Electrocardiograms showed right axis deviation. An echocardiogram demonstrated pericardial effusion, severe tricuspid regurgitation, pulmonary hypertension (pulmonary artery pressure was 78 mmHg) and normal left ventricular systolic function (the estimated ejection fraction was 77%). Contrast-enhance chest CT showed no evidence of intraluminal thrombi in the pulmonary arteries but central pulmonary artery dilatation (Figure 2). Chest CT image in a bone window setting showed osteosclerotic lesions in the vertebral body of the thoracic spine (arrow head) and sternum (white arrow), as well as proliferative new bone formation over the right transverse process (black arrow) (Figure 3). She was admitted and initially treated as having pulmonary hypertension with right heart failure. Figure 1. Chest radiograph demonstrates cardiomegaly, enlargement of the central pulmonary vessels and bilateral pleural effusions with more on …