TROMBOEMBOLISMO PULMONAR SUBMASIVO ASOCIADO A HIPERTENSION PULMONAR SEVERA. REPORTE DE UN CASO. HOSPITAL SANTO TOMÁS. ENERO 2009

Calixto Duarte Chang

Enviado marzo 28, 2025

Publicado 2026-04-06

Artículos de Investigación

Vol. 21 Núm. 2 (2008): Revista Médico Científica

TROMBOEMBOLISMO PULMONAR SUBMASIVO ASOCIADO A HIPERTENSION PULMONAR SEVERA. REPORTE DE UN CASO. HOSPITAL SANTO TOMÁS. ENERO 2009

Calixto Duarte Chang⁺⁻

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Publicado: 2026-04-06

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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.

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Presentamos el caso de una paciente femenina de 45 años de edad que cursó con cuadro de disnea progresiva, taquicardia, taquipnea y edema indurado de miembros inferiores con centelleo Ventilación Perfusión (V/Q) que reportó Tromboembolismo Pulmonar y Ecocardiograma Transtorácico con datos que sugieren hipertensión pulmonar severa.

Se inició anticoagulación como medida terapéutica; sin embargo, se plantea la posibilidad de un factor predisponente para Tromboembolismo Pulmonar, tal es el caso de enfermedad maligna o trombofílica de fondo.

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Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158:585-93.
Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Arch Intern Med 1991; 151:933-8.
Pengo V, Lensing AWA, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257-64.
Minichello T, Fogarty, P. Diagnosis and Management of Venous Thromboembolism. Med Clin N Am 2008; 92:443-65.
Jones K and Harrigan R. ABC of clinical electrocardiography: Conditions affecting the right side of the heart. BMJ 2002;324:1201-4
Verso, M, Agnelli, G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21:3665.
Mustafa, S, Stein, PD, Patel, KC, et al. Upper extremity deep venous thrombosis. Chest 2003; 123:1953.
Flinterman, LE, Van Der, Meer FJ, Rosendaal, FR, Doggen, CJ. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost 2008; 6:1262.
Baker W, Bick R. Controversies and Unresolved Issues in Antiphospholipid Syndrome. Pathogenesis and Management. Hematol Oncol Clin N Am 2008; 22:155-74.
Murchison JT, Wylie L, Stockton DL. Excess risk of cancer in patients with primary venous thromboembolism: a national, population-based cohort study. Br J Cancer 2004;91(1):92–5.
Stein PD, Terrin ML, Hales CA, et al: Clinical, laboratory, roentgenografic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest1991; 100:598-603.
Stein PD, Henry JW: Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes.Chest1997; 112:974-9.
The PIOPED Investigators: Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).JAMA1990; 263:2753-9.
Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 1992;85:462–8
Mullins MD, Becker DM, Hagspiel KD, et al. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Intern Med 2000;160(3):293–8.
Wolde M, Sohne M, Quak E, et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004;164(15):1685–9.
Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004;110:744-9.
Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002;347(15):1143–50.
van Belle A, Buller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithmcombining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295(2):172–9.
Oudkerk M, Van Beek EJ, Wielopolski P, et al. Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002; 359:1643–7.
Kucher N, Rossi E, De Rosa M, et al Prognostic role of echocardiography among patientswith acute pulmonary embolism and a systolic arterial pressure of 90mmHg or higher. Arch Intern Med 2005;165(15):1777–81.
Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004;110(6):744–9.

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[1] Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158:585-93.

[2] Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Arch Intern Med 1991; 151:933-8.

[3] Pengo V, Lensing AWA, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257-64.

[4] Minichello T, Fogarty, P. Diagnosis and Management of Venous Thromboembolism. Med Clin N Am 2008; 92:443-65.

[5] Jones K and Harrigan R. ABC of clinical electrocardiography: Conditions affecting the right side of the heart. BMJ 2002;324:1201-4

[6] Verso, M, Agnelli, G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21:3665.

[7] Mustafa, S, Stein, PD, Patel, KC, et al. Upper extremity deep venous thrombosis. Chest 2003; 123:1953.

[8] Flinterman, LE, Van Der, Meer FJ, Rosendaal, FR, Doggen, CJ. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost 2008; 6:1262.

[9] Baker W, Bick R. Controversies and Unresolved Issues in Antiphospholipid Syndrome. Pathogenesis and Management. Hematol Oncol Clin N Am 2008; 22:155-74.

[10] Murchison JT, Wylie L, Stockton DL. Excess risk of cancer in patients with primary venous thromboembolism: a national, population-based cohort study. Br J Cancer 2004;91(1):92–5.

[11] Stein PD, Terrin ML, Hales CA, et al: Clinical, laboratory, roentgenografic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest1991; 100:598-603.

[12] Stein PD, Henry JW: Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes.Chest1997; 112:974-9.

[13] The PIOPED Investigators: Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).JAMA1990; 263:2753-9.

[14] Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 1992;85:462–8

[15] Mullins MD, Becker DM, Hagspiel KD, et al. The role of spiral volumetric computed tomography in the diagnosis of pulmonary embolism. Arch Intern Med 2000;160(3):293–8.

[16] Wolde M, Sohne M, Quak E, et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004;164(15):1685–9.

[17] Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004;110:744-9.

[18] Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002;347(15):1143–50.

[19] van Belle A, Buller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithmcombining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295(2):172–9.

[20] Oudkerk M, Van Beek EJ, Wielopolski P, et al. Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002; 359:1643–7.

[21] Kucher N, Rossi E, De Rosa M, et al Prognostic role of echocardiography among patientswith acute pulmonary embolism and a systolic arterial pressure of 90mmHg or higher. Arch Intern Med 2005;165(15):1777–81.

[22] Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004;110(6):744–9.

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