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Pulmonary Hypertension after Splenectomy?

Marius M. Hoeper, MD; Jost Niedermeyer, MD; Frank Hoffmeyer, MD; Peer Flemming, MD; and Helmut Fabel, MD
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From Hannover Medical School, Hannover, Germany.


Ann Intern Med. 1999;130(6):506-509. doi:10.7326/0003-4819-130-6-199903160-00014
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Background: A high prevalence of asplenia has been observed in patients with unexplained pulmonary hypertension.

Objective: To describe the clinical and histopathologic characteristics of patients with postsplenectomy pulmonary hypertension and to compare the prevalence of surgical asplenia in patients with idiopathic pulmonary hypertension and patients with other pulmonary diseases.

Design: Case series and case–control study.

Setting: University hospital in Hannover, Germany.

Patients: 61 patients with pulmonary hypertension and 151 lung transplant recipients.

Results: The prevalence of asplenia in patients with pulmonary hypertension was 11.5% (95% CI, 4.7% to 22.2%) compared with 0% (CI, 0% to 3.2%) in those without pulmonary hypertension (P < 0.001). Histopathologic examination of lung specimens from patients with postsplenectomy pulmonary hypertension showed intimal fibrosis, plexiform lesions, and abundant thrombotic lesions.

Conclusion: Patients who have had splenectomy may be at increased risk for developing pulmonary hypertension.

Figures

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Figure.
Lung specimens from patients with pulmonary hypertension after splenectomy.Top left.Top right.Bottom left.Bottom right.

All sections were stained with hematoxylin and eosin. Pulmonary artery with laminar intimal fibrosis from patient 6 (original magnification, ×100). Other pulmonary arteries from the same patient show features of organization and recanalization of thrombus (original magnification, ×100). The pulmonary arteries in the transplanted lungs of the same patient 5 years after transplantation show intimal thickening and organized thrombi resembling those found in the native lungs (original magnification, ×100). Two pulmonary arteries showing intimal thickening and recanalized thrombi from patient 1 (original magnification, ×40).

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