Correspondence Address:
Tarek Safwat
Department of Respiratory Medicine, Ain Shams University Hospital, Cairo
Egypt

Full Text

A 52-year-old man, heavy smoker presented with shortness of breath of one month duration to the Respiratory Intensive Care Unit (RICU) of Ain Shams University Hospital. He gave history of orthopnoea and pedal oedema. On admission the patient was tachypnoeic (RR 26/min) and had jaundice. His blood pressure was 100/70 mm Hg. He had features of congestive heart failure with congested pulsating neck veins and bilateral lower limb pitting edema.

Physical examination revealed visible left parasternal pulsations and also left parasternal thrill. There was a bulge over the left infraclavicular and mammary areas. On percussion, there was stony dullness and on auscultation, there was diminished intensity of vesicular breath sounds over the same areas. The pulmonary component of the second sound was accentuated. Chest X-ray showed dilated main pulmonary artery. [Figure 1]. Echocardiography revealed severe pulmonary hypertension with aneurysmal dilatation of the main pulmonary artery (measuring 11 cm) and its main branches. There was dilatation of right-sided cardiac chambers, and severe tricuspid regurgitation. Pericardiocentesis revealed an exudative reaction and the culture was sterile. Abdominal ultrasound revealed moderate ascites, coarse cirrhotic liver with congested hepatic veins.

CT scan of the chest with angiography showed pericardial effusion, mild bilateral pleural and massive ascitis. The CT scan of the chest with angiography showed the dilated main pulmonary artery (X) [Figure 2] and dilated right ventricle (RV) [Figure 3]. It also showed pericardial effusion and mild bilateral pleural effusion. Based on all the investigative reports, the patient was initiated on positive inotropic drugs, sildenafil and diuretics. After one week of treatment, the patient was discharged from the ICU on advice to continue with the same drugs and is now on follow-up.