PMC10293931_01
Chest X-ray showing cardiomegaly and pulmonary vascular congestion (a), high-resolution chest computed tomography scan showing ground-glass opacities, bilateral pleural effusions, and interlobular septal thickening (b), computed tomography pulmonary angiogram being negative for pulmonary embolism (c), and lung perfusion scintigraphy being negative for deep vein thrombosis and pulmonary embolism (d).
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F1
Chest X-ray showed cardiomegaly and pulmonary vascular congestion (Fig. 1a). Hg, and a right ventricular systolic pressure of 47 mm Hg. High-resolution chest CT showed ground-glass opacities, bilateral pleural effusions, and interlobular septal thickening (Fig. 1b). Although the plasma D-dimer level was elevated to 4.8 mug/mL, CT pulmonary angiogram was negative for pulmonary embolism (Fig. 1c). Lung perfusion scintigraphy was negative for deep vein thrombosis and pulmonary embolism (Fig. 1d).
Twelve-lead electrocardiogram performed on admission showing poor R progression in leads V2-6.
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F2
A 12-lead electrocardiogram showed poor R-wave progression, which was not found in previous studies (Fig. 2).
Transthoracic ultrasound cardiography findings. Images taken on day 2 of hospitalization showing dilation of the right ventricle in the parasternal long-axis view (a) and a D-shaped left ventricle in the parasternal short-axis view (b), which indicate right ventricular overload. Improved findings after treatment (day 29 of hospitalization) (c, d).
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F3
Transthoracic ultrasound cardiography suggested right ventricular overload, specifically with dilation of the right ventricle (Fig. 3a), a D-shaped left ventricle with an average ejection fraction (Fig. 3b), a tricuspid regurgitation peak gradient of 32 mm Subsequently, the patient's symptoms, pulmonary edema on radiography, and right ventricular overload on ultrasound cardiography gradually improved (Fig. 3c, d).