case_images: PMC6501236_01
case_images: Apical four-chamber views and abbreviated echocardiogram reports from the baseline, acute chest syndrome (ACS), and follow-up. (a) Baseline echocardiogram. Twenty-two months prior to ACS. Left ventricular ejection fraction 55-60%. Moderately enlarged right ventricular chamber with mildly reduced systolic function. Mild right atrial enlargement. Moderate tricuspid regurgitation. Pulmonary artery systolic pressure 60 mmHg plus central venous pressure. Inferior vena cava small and collapses with inspiration. (b) Echocardiogram during ACS. Left ventricular ejection fraction 60-65%. Severely enlarged right ventricular chamber with moderately reduced systolic function. Severe right atrial enlargement. Severe tricuspid regurgitation. Pulmonary artery systolic pressure 132 mmHg plus central venous pressure. Inferior vena cava dilated. (c) Follow-up echocardiogram. Ten months after ACS. Left ventricular ejection fraction 55-60%. Moderately enlarged right ventricular chamber with moderately reduced systolic function. Moderate right atrial enlargement. Moderate tricuspid regurgitation. Pulmonary artery systolic pressure 45 mmHg plus central venous pressure. Inferior vena cava normal in caliber and collapses with inspiration.
case_images: CRIC2019-4681392.001.jpg
case_images: PMC6501236_01_CRIC2019-4681392.001.jpg
case_images: fig1
case_images: RV with mildly reduced function and estimated pulmonary artery systolic pressure (ePASP) of 60 mmHg (Figure 1(a)). Right heart catheterization (RHC) nineteen months prior to admission showed mild precapillary Chest radiograph showed slight left greater than right suprahilar opacities (Figure 1(b)), and computed tomography angiogram did not demonstrate a pulmonary embolism. Follow-up echocardiogram ten months after hospitalization on selexipag and macitentan showed improved RV size and function with ePASP 45 mmHg (Figure 1(c)).
case_images: Chest radiograph from time of acute chest syndrome diagnosis.
case_images: CRIC2019-4681392.002.jpg
case_images: PMC6501236_01_CRIC2019-4681392.002.jpg
case_images: fig2
case_images: Echocardiogram revealed a severely enlarged RV with severely reduced systolic function and an ePASP of 132 mmHg (Figure 2).