case_images: PMC6381583_01
case_images: Parasternal short-axis view showing a flattening of the intraventricular septum during systole. Enlargement and hypertrophy of the right ventricle are also shown. RV, right ventricle; LV, left ventricle.
case_images: CRIPE2019-2853632.001.jpg
case_images: PMC6381583_01_CRIPE2019-2853632.001.jpg
case_images: fig1
case_images: Milrinone infusion was added as the right ventricular function was depressed on echocardiogram (TAPSE 6 mm, Z-score -4), which demonstrated evidence of systemic to suprasystemic right ventricular pressure and bidirectional shunting across the ASD (Figures 1 and 2).
case_images: Color compared from the subcostal coronal view that shows moderate size secundum ASD with bidirectional shunting supporting findings of elevated RV pressure.
case_images: CRIPE2019-2853632.002.jpg
case_images: PMC6381583_01_CRIPE2019-2853632.002.jpg
case_images: fig2
case_images: Milrinone infusion was added as the right ventricular function was depressed on echocardiogram (TAPSE 6 mm, Z-score -4), which demonstrated evidence of systemic to suprasystemic right ventricular pressure and bidirectional shunting across the ASD (Figures 1 and 2).
case_images: (a) Chest X-ray on admission showing bilateral pulmonary edema with pleural effusions. (b) Pleural effusion unresponsive to therapy with diuretics (hospital day #6).
case_images: CRIPE2019-2853632.003.jpg
case_images: PMC6381583_01_CRIPE2019-2853632.003.jpg
case_images: fig3
case_images: He was on diuretic therapy (bumetanide infusion up to 10 mcg/kg/hr) as chest X-ray demonstrated evidence of bilateral interstitial edema with bilateral pleural effusions on admission (Figure 3) and confirmed by chest ultrasound.
case_images: (A-C) Subpleural cysts lined by pneumocytes are seen in both lungs which contain macrophages, sloughed pneumocytes, and neutrophils ((A) H&E x40 and (B) H&E x20). (C) Immunohistochemistry with anti-D2-40 antibody, a marker for lymphatic endothelium, was negative. (D) Lung parenchyma demonstrates chronic interstitial lung disease with alveolar septal thickening, capillary disorganizing, and hemosiderosis (H&E x40). (E) Acute bronchopneumonia is present (H&E x40). (F) Pulmonary hypertensive changes are present with variable severities (H&E x100).
case_images: CRIPE2019-2853632.004.jpg
case_images: PMC6381583_01_CRIPE2019-2853632.004.jpg
case_images: fig4
case_images: No lymphatic dilatation was observed on H&E or D2-40 immunostained slides; therefore, lymphangiectasia was ruled out (Figure 4).