PMC5359795_01
Right (R) lateral recumbent radiograph of the thorax, day 1. Note the
cardiomegaly and dilated, tortuous pulmonary lobar arteries
10.1177_2055116915579680-fig1.jpg
PMC5359795_01_10.1177_2055116915579680-fig1.jpg
fig1-2055116915579680
On three-view thoracic radiographs, the vertebral heart size (VHS) was 7.9 (upper limit of reference range 8.0), and the pulmonary lobar arteries were dilated and tortuous (Figures 1 and 2).
Ventrodorsal thoracic radiograph, day 1. L = left
10.1177_2055116915579680-fig2.jpg
PMC5359795_01_10.1177_2055116915579680-fig2.jpg
fig2-2055116915579680
On three-view thoracic radiographs, the vertebral heart size (VHS) was 7.9 (upper limit of reference range 8.0), and the pulmonary lobar arteries were dilated and tortuous (Figures 1 and 2).
Right parasternal four-chamber view. Note the high-septal atrial septal
defect, right ventricular (RV) concentric hypertrophy, right atrial (RA)
enlargement, and severely dilated right pulmonic artery (PA). LV = left
ventricle; LA = left atrium
10.1177_2055116915579680-fig3.jpg
PMC5359795_01_10.1177_2055116915579680-fig3.jpg
fig3-2055116915579680
The right atrium was subjectively severely enlarged, and there was severe dilation of the main pulmonary artery (PA) and right PA branch (PA:aorta ratio 1.9) (Figures 3 and 4).
Right parasternal four-chamber view with colour Doppler interrogation of the
atrial septum. Note the right-to-left shunting through the atrial septum
defect (ASD) just before the onset of the QRS complex on the
electrocardiogram. LA = left atrium; RA = right atrium
10.1177_2055116915579680-fig4.jpg
PMC5359795_01_10.1177_2055116915579680-fig4.jpg
fig4-2055116915579680
The right atrium was subjectively severely enlarged, and there was severe dilation of the main pulmonary artery (PA) and right PA branch (PA:aorta ratio 1.9) (Figures 3 and 4). A 5.7 mm atrial septal defect (ASD) was identified with right-to-left shunting on colour Doppler, with a maximum velocity of approximately 0.45 m/s (estimated peak instantaneous pressure gradient of 0.81 mmHg) (Figure 4).
Right parasternal short axis view with continous wave Doppler interrogation
of the pulmonic valve. Note the signal associated with pulmonic
insufficiency that is directed towards the probe
10.1177_2055116915579680-fig5.jpg
PMC5359795_01_10.1177_2055116915579680-fig5.jpg
fig5-2055116915579680
An insufficiency jet between the dilated PA and RV measured across the pulmonic valve was 4.1 m/s (estimated peak instantaneous diastolic pressure gradient of 68 mmHg), consistent with moderate-to-severe pulmonary hypertension (PH) (Figures 5 and 6).
Right parasternal short axis view showing pulmonic valvular insufficiency. PA
= pulmonary artery; Ao = aorta; LA = left atrium
10.1177_2055116915579680-fig6.jpg
PMC5359795_01_10.1177_2055116915579680-fig6.jpg
fig6-2055116915579680
An insufficiency jet between the dilated PA and RV measured across the pulmonic valve was 4.1 m/s (estimated peak instantaneous diastolic pressure gradient of 68 mmHg), consistent with moderate-to-severe pulmonary hypertension (PH) (Figures 5 and 6).