PULMONARY ARTERIAL-HYPERTENSION PRESENTING AS AN ACUTE ABDOMEN

The case is reported of a 49-year-old chronic alcoholic woman, who presented with severe pulmonary arterial hypertension (PAH) mimicking as an acute abdomen. She was admitted with right-sided hypochondrial abdominal pain and hepatomegaly, with a moderate jaundice. On admission to intensive care unit, she had an arterial blood pressure of 110/70 mmHg, a heart rate of 100 b . min-1, and a respiratory rate of 36 c . min-1. An electrocardiogram showed sinus rhythm and right-sided heart failure. Whilst breathing 61 . min-1 oxygen, her arterial blood gases were : PaO2 47 mmHg PaCO2 29 mmHg. Severe PAH was confirmed by measuring her mean pulmonary arterial pressure, which was 46 mmHg, whilst her pulmonary wedge pressure was 7 mmHg. Hepatic function was also altered : total bilirubin 41-mu-mol . l-1, alkaline phosphatase 145 UI . l-1 and gamma glutamyl transferase 1 340 UI . l-1. She developed arterial hypotension, which did not respond to increasing doses of isoproterenol. She died on the third day. Necropsy confirmed the diagnosis of primary PAH, with acute <<cardiac liver>>.