PMC5760875_01
Patient with leg ulcer with sickle cell disease and pulmonary hypertension
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F1
Apart from the SCD, the patient had a history of chronic venous stasis ulcer, which was being managed on an outpatient basis [Figure 1].
(a and b) Computed tomography of the chest showing a diffuse mosaic attenuation of the lung parenchyma
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F2
For further evaluation, the patient had a computed tomography pulmonary angiogram (CTPA), which demonstrated diffuse mosaic attenuation of lung parenchyma as seen in diseases such as chronic thromboembolic (CTE) disease [Figure 2a and b]. A mildly dilated pulmonary artery was also noted [Figure 2a].
(a) Pulmonary angiogram showing filling defects in the right middle lobe and right lower lobe. (b) Pulmonary angiogram showing filling defects on the left side
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F3
The pulmonary angiogram demonstrated filling defects in the right lower and middle lobes and left lower lobe, consistent with CTE disease [Figure 3a and b].
Clot removed after pulmonary thromboendarterectomy
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F4
Two months later, the patient underwent a successful pulmonary endarterectomy (PEA) with removal of the thrombus [Figure 4].
Healing lung ulcer status post pulmonary thromboendarterectomy
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F5
Interestingly, on follow-up, it was also noted that the patient's chronic venous stasis ulcer showed remarkable improvement with improvement in his oxygen saturation and improvement in his functional status [Figure 5].