PMC5604951_01
Supraventricular tachycardia with features of right ventricular strain.
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An electrocardiogram (ECG) showed a supraventricular tachycardia (SVT), which was terminated following synchronized electrical cardioversion, using intravenous midazolam titrated to effect for sedation under the direction of an emergency medicine physician (Fig. 1).
Sinus rhythm, right axis deviation, p - pulmonale, an S1T3 pattern, a qR pattern in V1 and T wave inversion in V2-V4 suggesting right ventricular hypertrophy and pressure overload.
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S1T3 pattern; a qR pattern in lead V1; T wave inversion in leads V2-V4 and p - pulmonale (Fig. 2). Subsequently, the patient was started on therapeutic low molecular weight heparin along with intravenous amiodarone, to maintain sinus rhythm and prevent the possible recurrence of the hemodynamically unstable supraventricular tachycardia, and admitted to the Intensive Care Unit for monitoring.
A chest radiograph with oligemia and volume loss of the right lung field and an empty right pulmonary bay. The left lung filed is plethoric with compensatory hyperinflation and an enlarged left pulmonary artery.
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On chest radiograph, a small oligaemic right lung field and empty right pulmonary bay (hilum) was noted with hyperinflation and plethora of the left lung field and a prominent left pulmonary artery (Fig. 3).
Computed tomography pulmonary angiogram showing an absent right pulmonary artery with abrupt cut - off and atresia at its origin (arrow).
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The computed tomography pulmonary angiogram (CTPA), following close review, demonstrated an absent right pulmonary artery with abrupt cutoff and atresia after its origin and no collateral circulation to the right lung was noted (Fig. 4, Fig. 5).
Cardiac magnetic resonance imaging showing an absent atretic right pulmonary artery (arrow).
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A massive right pulmonary artery clot was excluded and the atretic right pulmonary artery was confirmed on cardiac magnetic resonance imaging (MRI), which also showed an increased right ventricular mass and end-systolic volume with reduced systolic function (Fig. 6).