PMC6010588_01
Single view CXR revealing fibronodular changes in both apices without infiltrates or effusions.
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A chest x-ray (CXR) (Fig. 1) revealed fibronodular changes in both apices without infiltrates or effusions.
CTA of the chest demonstrating extensive ground glass opacities with bilateral calcified pulmonary nodules most pronounced in the right upper lobe, and a dilated left atrium. No pulmonary embolism or AVM was seen.
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A chest computer tomography angiogram (CTA) (Fig. 2) revealed extensive ground glass opacities, bilateral calcified pulmonary nodules most pronounced in the right upper lobe, and a dilated left atrium.
Bronchoscopic view of the trachea demonstrating engorged veins in the trachea and proximal right and left bronchial trees.
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Bronchoscopy (Fig. 3) revealed engorged veins in the trachea and bilateral proximal bronchial trees.
TEE revealed severe rheumatic mitral valve stenosis with a mean gradient of 12 mmHg and Wilkins score of 11 with no LA appendage thrombus.
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TB, vasculitis or AVM unlikely. The dilated left atrium and severe mitral stenosis seen on TTE was confirmed by transesophageal echocardiogram (TEE), which showed a mean gradient of 12 mmHg and Wilkins score of 11 (see Fig. 4, Fig. 5, Fig. 6).
Imaging from the TEE with doppler revealing the stenotic mitral valve.
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TB, vasculitis or AVM unlikely. The dilated left atrium and severe mitral stenosis seen on TTE was confirmed by transesophageal echocardiogram (TEE), which showed a mean gradient of 12 mmHg and Wilkins score of 11 (see Fig. 4, Fig. 5, Fig. 6).