Tuberc Respir Dis.  2007 Mar;62(3):211-216. 10.4046/trd.2007.62.3.211.

A Case of Pulmonary Thromboembolism in a Patient with Hyperhomocysteinemia

• Oh SE
• Jung JH
• Yoon SB
• Yoon HY
• Park JK
• Lee DH
• Hong SH
• Woo KH
• Choi S
• Lee SH
• Lee N

• KMID: 1518466
• DOI: http://doi.org/10.4046/trd.2007.62.3.211

Abstract

Hyperhomocysteinemia is an independent risk factor for cardiovascular, cerebrovascular and peripheral vascular diseases that are complicated by atherosclerosis and a thromboembolism. An increased level of plasma homocysteine develops from a genetic defect in the of enzyme for the homocysteine metabolism or a vitamin deficiency. Hyperhomocysteinemia has direct toxic effect on the vascular endothelium and causes damages to the antithrombotic action of vascular endothelial cells. Most cases of hyperhomocysteinemia are asymptomatic, but cardiopulmonary or cerebrovascular incidents developin rare cases. In the case of a thromboembolism with an unknown cause, hyperhomocysteinemia should be considered in a differential diagnosis. The authors report a case of pulmonary thromboembolism in a patient with hyperhomocysteinemia with a review of the relevant literature.

Keyword

Hyperhomocysteinemia; Pulmonary embolism

MeSH Terms

Atherosclerosis
Avitaminosis
Diagnosis, Differential
Endothelial Cells
Endothelium, Vascular
Homocysteine
Humans
Hyperhomocysteinemia*
Metabolism
Peripheral Vascular Diseases
Plasma
Pulmonary Embolism*
Risk Factors
Thromboembolism
Homocysteine

Figure

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  Figure 1 EKG showing atrial fibrillation, T-wave inversion at lead III and incomplete RBBB.

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  Figure 2 Echocardiography(parasternal short axis view) showing paradoxical septal motion(D-shaped LV).

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  Figure 3 Chest CT showing filling defect at the bifurcation site of bilateral pulmonary arteries.

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  Figure 4 Lung perfusion scan shows moderate photon defect in both lower lobes.

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  Figure 5 Schematic representation of homocysteine metabolism. MS:methionine synthase; MTHF:methylene tetrahydrofolate; MTHFR: methylene tetrahydrofolate reductase; CBS:cystathionine β synthase

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