Dyspnea and Right-Sided Heart Failure in a Patient With a History of Pneumonectomy

Our plain-English summary of Dyspnea and Right-Sided Heart Failure in a Patient With a History of Pneumonectomy, by S.W. Johnson, M.C. Kwan, S.A.M. Cuddy, et al (CHEST Pulmonary, 2025).

The study

• Authors: S.W. Johnson, M.C. Kwan, S.A.M. Cuddy, A.B. Waxman, L.P. Hariri, W.M. Oldham
• Journal: CHEST Pulmonary
• Published: 2025;3(2):100149
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 67-year-old man who never smoked was evaluated in the emergency department for 3 months of progressive dyspnea, lower extremity edema, and 20lb weight gain. Eighteen months before this, he had presented with hemoptysis and was ultimately found to have squamous cell lung cancer invading the left pulmonary artery without lymph node involvement, stage pT4N0M0, for which he underwent left pneumonectomy. His medical history was additionally notable for paroxysmal atrial fibrillation and factor V Leiden mutation (anticoagulated on apixaban). Social history was notable for work as a grocer in a supermarket; the patient denied history of asbestos exposure and had no known TB exposure or prior infection. The patient was admitted to general cardiology where he was afebrile, in atrial fibrillation with rapid ventricular response to 127 beats/min with associated hypotension (80/55 mm Hg); his oxygen saturation was 95% on room air. Physical examination was most notable for jugular venous distension and bilateral edema to the thigh. Electrocardiogram did not demonstrate ischemia. Laboratory evaluation demonstrated a creatinine level of 1.10 mg/dL, elevated from his recent baseline level of 0.52 mg/dL. Lactic acid was normal. His cardiac biomarkers were abnormal with an elevated N-terminal pro-B-type natriuretic peptide value (3,682 pg/mL) and high sensitivity troponin T (43 ng/L). Both WBC count and hemoglobin values were normal as were his thyroid hormone levels. IV diuretic and antiarrhythmic therapies were initiated with furosemide and amiodarone, respectively.

In plain English

This article was a case report of one patient, not a study of asbestos. Asbestos is mentioned only because the patient denied any history of asbestos exposure. He was a 67-year-old man who never smoked and had worked as a grocer in a supermarket. Eighteen months earlier, his left lung had been removed for squamous cell lung cancer invading the left pulmonary artery. He came to the emergency department with 3 months of worsening breathlessness, leg swelling and weight gain. Heart and lung tests showed right-sided heart failure and high pressure in the lung arteries. The pathology report from his earlier surgery had described amyloid protein deposits in the left pulmonary artery and lung capillaries, and testing of that tissue identified transthyretin amyloid (ATTR). The diagnosis was precapillary pulmonary hypertension due to ATTR amyloid. Sildenafil caused symptomatic low blood pressure. He was then treated with inhaled treprostinil and was stable as an outpatient. The authors concluded that systemic amyloidosis is an underrecognized cause of precapillary pulmonary hypertension.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 67-year-old man who never smoked. Eighteen months earlier he had undergone left pneumonectomy for squamous cell lung cancer. He was seen at hospitals affiliated with Harvard Medical School, Boston, MA.
• Exposure: No asbestos exposure was studied. The patient worked as a grocer in a supermarket and denied any history of asbestos exposure.
• Main results:
  • The pathology report from the patient's earlier left pneumonectomy described amyloid deposition in the left main pulmonary artery.
  • Mass spectrometry of the earlier surgical tissue found transthyretin-type (ATTR) amyloid.
  • In this patient, right heart catheterization showed a pulmonary vascular resistance of 5.5 Wood units on room air and 3.6 Wood units after inhaled nitric oxide.
  • The patient's diagnosis was precapillary pulmonary hypertension due to transthyretin amyloid involving the alveolar septa and the lung blood vessels.
  • On sildenafil 10 mg, the patient developed symptomatic low blood pressure, with systolic blood pressure falling from 110 to 70 mm Hg.
  • The patient was then treated with inhaled treprostinil and was stable at a recent outpatient visit.
• The authors' conclusion: The authors concluded that systemic amyloidosis is an underrecognized cause of precapillary pulmonary hypertension. They also stated that inhaled pulmonary vasodilator therapy may be an effective way to treat such patients.

Topics

Medical terms in this study, explained in our Lexicon: Dyspnea, Pneumonectomy, Hemoptysis, Squamous Cell Carcinoma, Lung Cancer, Asbestos Exposure, Oxygen Saturation, Bilateral.

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