case_images: PMC8197592_01
case_images: Status post remote pectus excavatum (PEX) repair twenty-two years ago.
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case_images: Hg with no orthostasis, heart rate of 97 beats/min, respiratory rate of 16 breaths/min with an oxygen saturation of 99% on ambient room air. His physical examination revealed a prominent anterior chest wall deformity with bilateral thoracotomy scars with an otherwise normal cardiorespiratory exam (Figure 1).
case_images: The patient's 12-lead electrocardiogram (ECG) displaying sinus rhythm with right bundle branch block (RBBB) and left anterior fascicular block (LAFB).
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case_images: A 12-lead electrocardiogram (ECG) revealed sinus rhythm with left atrial enlargement (LAE), right bundle branch block (RBBB), and left anterior fascicular block (LAFB) (Figure 2).
case_images: The patient's chest radiography.
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case_images: A chest radiograph displayed an obscured right heart border with an inferomedial "haziness" and narrow cardiac silhouette (Figure 3).
case_images: The patient's cardiac computed tomography angiogram (cCTA).
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case_images: A cardiac computed tomography angiogram (cCTA) revealed marked right ventricular (RV) free wall (Figure 4A) and infundibular outflow tract impingement (Figure 4B) with a Haller index of 5.2 (Figure 5) and ostial RCA compression or vasospasm (Figure 6).
case_images: The patient's cardiac computed tomography angiogram (cCTA) demonstrating a relatively severe Haller index of 5.2 indicated by the ratio of the transverse diameter (the horizontal distance of the inside of the rib cage) and the anteroposterior diameter (the shortest distance between the vertebrae and sternum).
case_images: IMCRJ-14-385-g0005.jpg
case_images: PMC8197592_01_IMCRJ-14-385-g0005.jpg
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case_images: A cardiac computed tomography angiogram (cCTA) revealed marked right ventricular (RV) free wall (Figure 4A) and infundibular outflow tract impingement (Figure 4B) with a Haller index of 5.2 (Figure 5) and ostial RCA compression or vasospasm (Figure 6).
case_images: The patient's cardiac computed tomography angiogram (cCTA) demonstrates the slit-like ostial right coronary artery compression or vasospasm between the green arrows.
case_images: IMCRJ-14-385-g0006.jpg
case_images: PMC8197592_01_IMCRJ-14-385-g0006.jpg
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case_images: A cardiac computed tomography angiogram (cCTA) revealed marked right ventricular (RV) free wall (Figure 4A) and infundibular outflow tract impingement (Figure 4B) with a Haller index of 5.2 (Figure 5) and ostial RCA compression or vasospasm (Figure 6).