case_images: PMC11345742_01
case_images: Digital clubbing presenting as bulbous uniform swelling of the soft tissue of the terminal phalanx of all digits with subsequent loss of the normal angle between the nail and nail bed.
case_images: fmed-11-1419092-g001.jpg
case_images: PMC11345742_01_fmed-11-1419092-g001.jpg
case_images: F1
case_images: Physical examination revealed a central cyanosis and a symmetrical digital clubbing (Figure 1), a grade 2 systo-diastolic cardiac murmur and a symmetrical absence of lung sounds at both lung bases.
case_images: Doppler echocardiography showing cardiac signs of PAH, including right ventricular dilatation, severe tricuspid regurgitation, and a severe right atrial dilatation.
case_images: fmed-11-1419092-g002.jpg
case_images: PMC11345742_01_fmed-11-1419092-g002.jpg
case_images: F2
case_images: A Doppler echocardiography detected an increased pulmonary artery pressure and other signs of pulmonary arterial hypertension (PAH), including right ventricular dilatation, severe tricuspid regurgitation and a severe right atrial dilatation (Figure 2); it also revealed the well-known sub-aortic ventricular septal defect associated with a bidirectional shunt.