case_images: PMC5359795_01
case_images: Right (R) lateral recumbent radiograph of the thorax, day 1. Note the
  cardiomegaly and dilated, tortuous pulmonary lobar arteries
case_images: 10.1177_2055116915579680-fig1.jpg
case_images: PMC5359795_01_10.1177_2055116915579680-fig1.jpg
case_images: fig1-2055116915579680
case_images: On three-view thoracic radiographs, the vertebral heart size (VHS) was 7.9 (upper limit of reference range 8.0), and the pulmonary lobar arteries were dilated and tortuous (Figures 1 and 2).
case_images: Ventrodorsal thoracic radiograph, day 1. L = left
case_images: 10.1177_2055116915579680-fig2.jpg
case_images: PMC5359795_01_10.1177_2055116915579680-fig2.jpg
case_images: fig2-2055116915579680
case_images: On three-view thoracic radiographs, the vertebral heart size (VHS) was 7.9 (upper limit of reference range 8.0), and the pulmonary lobar arteries were dilated and tortuous (Figures 1 and 2).
case_images: Right parasternal four-chamber view. Note the high-septal atrial septal
  defect, right ventricular (RV) concentric hypertrophy, right atrial (RA)
  enlargement, and severely dilated right pulmonic artery (PA). LV = left
  ventricle; LA = left atrium
case_images: 10.1177_2055116915579680-fig3.jpg
case_images: PMC5359795_01_10.1177_2055116915579680-fig3.jpg
case_images: fig3-2055116915579680
case_images: The right atrium was subjectively severely enlarged, and there was severe dilation of the main pulmonary artery (PA) and right PA branch (PA:aorta ratio 1.9) (Figures 3 and 4).
case_images: Right parasternal four-chamber view with colour Doppler interrogation of the
  atrial septum. Note the right-to-left shunting through the atrial septum
  defect (ASD) just before the onset of the QRS complex on the
  electrocardiogram. LA = left atrium; RA = right atrium
case_images: 10.1177_2055116915579680-fig4.jpg
case_images: PMC5359795_01_10.1177_2055116915579680-fig4.jpg
case_images: fig4-2055116915579680
case_images: The right atrium was subjectively severely enlarged, and there was severe dilation of the main pulmonary artery (PA) and right PA branch (PA:aorta ratio 1.9) (Figures 3 and 4). A 5.7 mm atrial septal defect (ASD) was identified with right-to-left shunting on colour Doppler, with a maximum velocity of approximately 0.45 m/s (estimated peak instantaneous pressure gradient of 0.81 mmHg) (Figure 4).
case_images: Right parasternal short axis view with continous wave Doppler interrogation
  of the pulmonic valve. Note the signal associated with pulmonic
  insufficiency that is directed towards the probe
case_images: 10.1177_2055116915579680-fig5.jpg
case_images: PMC5359795_01_10.1177_2055116915579680-fig5.jpg
case_images: fig5-2055116915579680
case_images: An insufficiency jet between the dilated PA and RV measured across the pulmonic valve was 4.1 m/s (estimated peak instantaneous diastolic pressure gradient of 68 mmHg), consistent with moderate-to-severe pulmonary hypertension (PH) (Figures 5 and 6).
case_images: Right parasternal short axis view showing pulmonic valvular insufficiency. PA
  = pulmonary artery; Ao = aorta; LA = left atrium
case_images: 10.1177_2055116915579680-fig6.jpg
case_images: PMC5359795_01_10.1177_2055116915579680-fig6.jpg
case_images: fig6-2055116915579680
case_images: An insufficiency jet between the dilated PA and RV measured across the pulmonic valve was 4.1 m/s (estimated peak instantaneous diastolic pressure gradient of 68 mmHg), consistent with moderate-to-severe pulmonary hypertension (PH) (Figures 5 and 6).