PMC10144409_01
The patient presented with the manifestation of (a) facial plethora and central cyanosis, (b) clubbing (Grade 3), (c) bilateral upper limb edema, (d) engorged neck veins with indistinct nonpulsatile JVP wave pressure. JVP: Jugular venous pressure
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F1
He had facial plethora, central cyanosis [Figure 1a], and Grade 3 clubbing [Figure 1b] with facial puffiness along with bilateral upper limb edema (right > left) [Figure 1c], engorged neck veins with indistinct nonpulsatile jugular venous pressure wave patterns, and prominent veins over the chest [Figure 1d] with the downward predominant flow.
Chest X-ray showing a mild increase in cardiothoracic ratio with normal pulmonary vasculature markings
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F2
Chest X-ray [Figure 2] showed a mild increase in cardiothoracic ratio with normal pulmonary vasculature markings.
Electrocardiography showing sinus tachycardia with right axis deviation with possible left atrial enlargement and right ventricle hypertrophy
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F3
Electrocardiography demonstrated sinus tachycardia with right axis deviation with possible left atrial enlargement and right ventricle hypertrophy [Figure 3].
Echocardiography showing tetralogy of Fallot with infundibular right ventricular outflow tract obstruction with confluent pulmonary arteries. RV: Right ventricle, LV: Left ventricle, IVS: Interventricular septum, AO: Aorta
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F4
Contrast-enhanced computerized tomography thorax showing thrombus in the right internal jugular vein (red arrow) extending into superior vena cava syndrome.
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F5
Contrast-enhanced computerized tomography thorax [Figure 5] revealed a thrombus in the right internal jugular vein extending into SVC.