PMC5582653_01
Absent first metacarpal.
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There was absent left first metacarpal (Figure 1).
Chest X-ray showed RA enlargement and RV type of apex.
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Chest X-ray showed normal pulmonary vascularity, mild prominence of main pulmonary artery and its left branch, and RV type of apex (Figure 2).
X-ray anteroposterior (AP) view of hand showing absent first metacarpal.
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Hand X-ray confirmed the absence of left first metacarpal (Figure 3).
Doppler echo showing gradient of 60 mmHg through pulmonary valve.
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The pulmonary valve had thickened and immobile leaflets, absence of doming, hypoplastic valve annulus and minimal post-stenotic pulmonary artery dialation. The Doppler gradient across the valve was 60 mmHg (Figure 4).