case_images: PMC5582653_01
case_images: Absent first metacarpal.
case_images: 10.1177_2050313X17726946-fig1.jpg
case_images: PMC5582653_01_10.1177_2050313X17726946-fig1.jpg
case_images: fig1-2050313X17726946
case_images: There was absent left first metacarpal (Figure 1).
case_images: Chest X-ray showed RA enlargement and RV type of apex.
case_images: 10.1177_2050313X17726946-fig2.jpg
case_images: PMC5582653_01_10.1177_2050313X17726946-fig2.jpg
case_images: fig2-2050313X17726946
case_images: Chest X-ray showed normal pulmonary vascularity, mild prominence of main pulmonary artery and its left branch, and RV type of apex (Figure 2).
case_images: X-ray anteroposterior (AP) view of hand showing absent first metacarpal.
case_images: 10.1177_2050313X17726946-fig3.jpg
case_images: PMC5582653_01_10.1177_2050313X17726946-fig3.jpg
case_images: fig3-2050313X17726946
case_images: Hand X-ray confirmed the absence of left first metacarpal (Figure 3).
case_images: Doppler echo showing gradient of 60 mmHg through pulmonary valve.
case_images: 10.1177_2050313X17726946-fig4.jpg
case_images: PMC5582653_01_10.1177_2050313X17726946-fig4.jpg
case_images: fig4-2050313X17726946
case_images: 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).