title: Right heart and pulmonary thromboembolism from extensive splanchnic vein thrombosis after splenectomy for myeloproliferative disease.
abstract: BACKGROUND
  Splenectomy is a risk factor for both portal-vein and chronic thromboembolic pulmonary hypertension. The underlying mechanism is unclear, but may involve a hypercoagulable state.
  
  
  METHODS
  We describe 1 patient with polycythemia vera who developed extensive portal thrombosis of the portal, suprahepatic, and inferior cava veins, leading to right heart thromboembolism, with a resultant pulmonary embolism subsequent to splenectomy despite heparin prophylaxis.
  
  
  RESULTS
  In this patient, several mechanisms may have played a role, including perioperative stress, thrombocytosis, thrombophilia, and associated chronic liver disease. Nevertheless, combined treatment with intravenous heparin and thrombolysis and the myeloproliferative inhibitor hydroxyurea was associated with a favorable outcome.
  
  
  CONCLUSIONS
  The risk of pulmonary thromboembolic complications and their management after splenectomies for hematologic disease warrant further study.
authors.affiliation: Department of Respiratory Medicine, Monaldi Hospital, University Federico II of Naples, Naples, Italy.
authors.forename: Anna Agnese
authors.initials: AA
authors.lastname: Stanziola
authors.forename: Sergio
authors.initials: S
authors.lastname: Padula
authors.forename: Emanuela
authors.initials: E
authors.lastname: Carpentieri
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rea
authors.forename: Mauro
authors.initials: M
authors.lastname: Maniscalco
authors.forename: Matteo
authors.initials: M
authors.lastname: Sofia
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D009196:Myeloproliferative Disorders / Q000601:surgery*; D055420:Perfusion Imaging; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology*; D012720:Severity of Illness Index; D013152:Splanchnic Circulation; D013156:Splenectomy / Q000009:adverse effects*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis