PMC9534694_01
Chest X-ray on admission shows bilateral pulmonary infiltrates concerning for pulmonary edema vs. pneumonia.
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Chest X-ray showed pulmonary edema with bilateral interstitial infiltrates (Figure 1).
EKG on admission shows sinus tachycardia otherwise normal rhythm with no significant ST changes.
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EKG demonstrated persistent sinus tachycardia without ST or T wave changes (Figure 2).
Four-chamber view of TTE demonstrates global wall motion hypokinesis and reduced LV systolic function on admission in the setting of a structurally normal heart on hospital day 3 after diuresis. (a) Four-chamber view during diastole. (b) Four-chamber view during systole with decreased contractility and minimal changes in LV size.
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A TTE showed left ventricular global hypokinesis with a reduced ejection fraction of 25-30% without valvular abnormalities (Figure 3). A lumbar puncture was performed, which showed pleocytosis with no evidence of bacterial infection, and the meningitis viral panel was negative (Cytomegalovirus, Enterovirus, Herpes Simplex Virus 1/2, Human Herpesvirus 6, Human Parechovirus, and Varicella Zoster Virus).
Left ventricular view of TTE with perflutren contrast demonstrates preserved LV ejection fraction with excellent contractility and the absence of thrombus prior to hospital discharge. (a) Left ventricle during diastole. (b) Left ventricle during systole.
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TTE now showed EF > 50% with significantly improved global wall motion abnormalities (Figure 4). The patient was transferred to inpatient rehab shortly after extubation.