Dear Friends,
Muppet considers himself a celebrity and, like everybody else, he wants to show you a selfie. Today’s case is provided by my good friend Dr. Fernandez Alarza. Radiographs belong to a 33-year-old woman with moderate dyspnoea. I showed it to Muppet and since he is the smartest guy in the Universe, he made the right diagnosis up to the last finding.
Can you guess Muppet’s diagnosis? What do you see?
Leave your thoughts in the comments section and come back on Friday for the answer.
Click here for the answer to case #88
Findings: PA chest shows a small right hemithorax, with displacement of the heart towards rhe right, haziness of the heart border and a scimitar vein (arrows). These findings are characteristic of congenital hypogenetic lung. In addition, there is prominence of the pulmonary trunk (red arrow) and increased pulmonary vascularity. These findings point towards a left-to-right shunt (see Dr. Pepe’s Diploma Casebook case 52).
Coronal CT confirms the scimitar vein (arrows), as well as an enlarged right atrium B, arrows), due to a shunt at the atrial level, confirmed at surgery.
Final diagnosis: hypogenetic lung syndrome, associated to an ostium secundum defect.
Congratulations to Murzin, who made the right diagnosis.
Teaching point: this is a nice case of satisfaction of search. Discovering the obvious alteration (hypogenetic lung) leads us to stop investigating and miss the left-to-right shunt, which is more important in the management of the patient.
