{
  "abstract": "A 42-year-old man presented with an 11-month history of progressive exertional dyspnoea and leg swelling. His 6 min walk distance (6MWD) was 345 m. Three months before admission, blood tests revealed an elevated D-dimer level of 3.56 mg/L (<0.5 mg/L), B-type natriuretic peptide (BNP) level of 860 pg/mL (<100 pg/mL) and creatinine level of 251.70 µmol/L (35–106 μmol/L). No evidence of deep vein thrombosis was found on lower extremity ultrasonography. Echocardiography showed right heart enlargement with a right-to-left ventricular ratio of 2.1, right ventricular hypertrophy (wall thickness, 5.4 mm) and an increased estimated systolic pulmonary artery pressure (PAP) of 65 mmHg. A pulmonary ventilation–perfusion scan identified mismatched perfusion deficits, and CT pulmonary angiography (CTPA) showed filling defects primarily in the left pulmonary arterial trunk. Upon these findings, therapy with the anticoagulant rivaroxaban was immediately initiated. Despite a partial reduction in the D-dimer level to 1.67 mg/L, the patient showed no significant improvement on repeat CTPA ( figure 1). One week before admission, a right heart catheterisation confirmed precapillary pulmonary hypertension (PH) with a mean PAP of 39 mmHg, pulmonary artery wedge pressure of 7 mmHg and pulmonary vascular resistance of 7.16 Wood Units. A biopsy revealed a thrombus in the left pulmonary artery. The patient’s medical history included 5 years of proptosis without hyperthyroidism (figure 1).",
  "authors": [
    {
      "affiliations": [
        "National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Integrative Pulmonary Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China",
        "National Center for Integrative Medicine, Beijing, China"
      ],
      "name": "Yuebo Song"
    },
    {
      "affiliations": [
        "Department of Pulmonary and Critical Care Medicine, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, China"
      ],
      "name": "Fajiu Li"
    },
    {
      "affiliations": [
        "National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Integrative Pulmonary Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China",
        "National Center for Integrative Medicine, Beijing, China",
        "National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"
      ],
      "name": "Wanmu Xie"
    },
    {
      "affiliations": [
        "Department of Pathology, China-Japan Friendship Hospital, Beijing, China"
      ],
      "name": "Ling Zhao"
    },
    {
      "affiliations": [
        "Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China"
      ],
      "name": "Huan Li"
    },
    {
      "affiliations": [
        "Department of Pulmonary and Critical Care Medicine, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, China"
      ],
      "name": "Ziyang Zhu"
    },
    {
      "affiliations": [
        "Department of Pulmonary and Critical Care Medicine, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, China"
      ],
      "name": "Chenghong Li"
    },
    {
      "affiliations": [
        "National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"
      ],
      "name": "Shuai Zhang"
    },
    {
      "affiliations": [
        "National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"
      ],
      "name": "Zhenguo Zhai"
    }
  ],
  "title": "Is it truly chronic thromboembolic pulmonary hypertension? A case of pulmonary hypertension with proptosis",
  "uid": "2c5b596a-4699-579e-a185-16130d3dda66"
}