Abstract
I read with great interest the case of “wiped out” by Brastianos et al in the Diagnostic Dilemma Section of the Journal;1 however, I think the dilemma in the management of the symptoms of this patient still persists at the end of the discussion. The authors record that the patient notes an improvement in dyspnea with repeated blood transfusions. The lack of considerable improvement of the dyspnea might be related to underdiagnosed pulmonary hypertension. An echocardiography or cardiac catheterisation study should have been undertaken in this patient to exclude pulmonary hypertension, especially because computed tomography scan might not identify this complication.
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