PMC4007781_01
Chest radiography with a marked cardiomegaly suggesting massively dilated right atrium (RA). Cardio thoracic ratio was 89%.
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fig1
Transthoracic echocardiography, apical four chambers view. Massive enlargement of the right atrium. The right atrial area was 80.6 cm2 (53.7 cm2/m2), and the calculated right atrial volume was 621 mL (414 mL/m2). LA: left atrium. LV: left ventricle. RA: right atrium. RV: right ventricle.
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fig2
The right atrial area was 80.6 cm2 (53.7 cm2/m2), and the calculated right atrial volume was 621 mL (414 mL/m2); see Figure 2. 
Transthoracic echocardiography, four apical four chambers view. Dilatation of the right ventricle (52.5 mm, mild diameter). The tricuspid valve was thickened and not displaced (white arrow).
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fig3
The right ventricle was dilated (52.5 mm, mild diameter, apical 4 chambers view, Figure 3). The tricuspid valve was not displaced but was thickened (Figure 3) with restrictive mobility in systole and no coaptation.
Transthoracic echocardiography, left parasternal long axis view M-mode. (a) dilatation of the left atrium. (b) Paradoxical anterior motion of posterior mitral leaflet (white arrow), with reduced separation of the two leaflets. Reduction of EF slope (broken arrow). (c) Normal left ventricular size, paradoxical septal motion.
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fig4
The left atrial diameter was 66.4 mm (44.3 mm/m2) (Figure 4(a)) without any thrombus. The mitral valve was thickened with a hockey stick appearance in M mode:Figure 4(b). The ejection fraction was 64% (Figure 4(c)).