PMC6332819_01
Patient's electrocardiogram 2 mo prior to admission and at admission. The electrocardiogram was normal 2 mo prior to admission (A) but revealed sinus tachycardia, SIQIIITIII pattern, inverted t waves in V
2, and flattened t waves in V
3-4 at admission (B)
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The patient had a normal echocardiogram and electrocardiogram (ECG) at 20 months and two months prior to admission, respectively (Figures 1A and 2A,B). A new ECG demonstrated sinus tachycardia, typical signs of right ventricular strain, that is, SIQIIITIII pattern, inverted t waves in V 2, and flattened t waves in V 3-4 (Figure 1B).
Patient's echocardiogram 20 mo prior to admission and at admission. Echocardiographic subxiphoid 4 chamber (A) and short-axis view (B) 20 mo prior to admission, and subxiphoid 4 chamber (C) and short-axis view (D) at admission. The echocardiogram was normal 20 mo prior to admission but revealed signs of severe right ventricular pressure overload and compression and D-sign deformation of the left ventricle at admission. See text for details
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The patient had a normal echocardiogram and electrocardiogram (ECG) at 20 months and two months prior to admission, respectively (Figures 1A and 2A,B). This included dilatation and systolic dysfunction of the right ventricle, tricuspid regurgitation and pulmonary hypertension, and compression and D-sign deformation of the left ventricle with reduced filling despite preserved left ventricular ejection fraction (Figure 2C,D).
Patient's computed tomography pulmonary angiogram with three-dimensional reconstruction of the pulmonary arteries seen from the rear. The computed tomography pulmonary angiogram revealed severe right-sided dilatation (A). There was contrast filling in both pulmonary arteries beyond the segmental arteries depicted by "*", and hence no signs of central pulmonary embolism (B). In addition, the computed tomography ruled out pneumonia and significant atelectasis and pleural fluid (C,D)
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An acute computed tomography pulmonary angiogram ruled out pulmonary embolism, pneumonia, and significant atelectasis and pleural fluid (Figure 3A,B).