case_images: PMC6348809_01
case_images: Central and peripheral cyanosis.
case_images: CRIHEP2019-6586478.001.jpg
case_images: PMC6348809_01_CRIHEP2019-6586478.001.jpg
case_images: fig1
case_images: On physical examination he had peripheral and central cyanosis (Figure 1), grade 4 clubbing (Figure 2), muscle wasting, needle marks, palmar erythema, and bilateral resting tremor but no asterixis.
case_images: Digital clubbing.
case_images: CRIHEP2019-6586478.002.jpg
case_images: PMC6348809_01_CRIHEP2019-6586478.002.jpg
case_images: fig2
case_images: On physical examination he had peripheral and central cyanosis (Figure 1), grade 4 clubbing (Figure 2), muscle wasting, needle marks, palmar erythema, and bilateral resting tremor but no asterixis.
case_images: Chest CT scan showing the prominent pulmonary vasculatures and irregular borders of the liver.
case_images: CRIHEP2019-6586478.003.jpg
case_images: PMC6348809_01_CRIHEP2019-6586478.003.jpg
case_images: fig3
case_images: Within 5 heart cycles from appearing in the right atrium, contrasts' microbubbles appeared in the left atrium and left ventricle (Figures 3 and 4).
case_images: Contrast-enhanced transthoracic echocardiography showing contrasts' microbubbles in the left side of the heart.
case_images: CRIHEP2019-6586478.004.jpg
case_images: PMC6348809_01_CRIHEP2019-6586478.004.jpg
case_images: fig4
case_images: Within 5 heart cycles from appearing in the right atrium, contrasts' microbubbles appeared in the left atrium and left ventricle (Figures 3 and 4).