Dr. Pepe’s Diploma Casebook: Case 3 – SOLVED!

Dear Friends,

Moving forward on our journey through the systems, our next stop is the heart. I want to put your diagnostic skills to the test with the following cardiac case.

Our patient is a 60-year-old male with dyspnea and fatigability.

Fig. 1

Fig. 2


1. Pulmonary hypertension
2. Pulmonary valvular stenosis
3. Left-to-right shunt
4. None of the above

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    10 Responses to : Dr. Pepe’s Diploma Casebook: Case 3 – SOLVED!

    1. mm says:

      . Left-to-right shunt through interatrial communication

    2. Mihai Comsa says:

      Left-to-right shunt with pulmonary hypertension.

    3. Genchi: Bari Italia says:

      Torace AP:segni di iperafflusso polmonare.TC: dilatazione del tronco polmonare e dell’atrio sx. Diagnosi: Shunt sx-dx( forame ovale pervio?).

    4. vishal kalia says:

      Chest x-ray PA and lateral view shows dilated left and right pulmonary arteries with peripheral pruning and cardiomegaly. No evidence of pleural effusion /calcification of the pulmonary arteries or any opacity(suggesting infarct) is seen. Pulmonary veins are not dilated and no lung parenchymal disease is seen ruling out capillary and post capillary causes of pulmonary hypertension.From x-ray, features are sugegstive of pulmonary arterial hypertension -precapillary cause. Out of three common precapillary causes -Chronic left to right shunt,chronic pulmonary thromboembolism and idiopathic; MR images show evidence of defect between the SVC and left atrium(sagittal images)-suggesting sinus venosus type of ASD with right sided chamber enlargement. My diagnosis is Chronic sinus venosus type of ASD with pulmonary hypertension. In pulmonary valve stenosis only main and left pulmonary artery will be dilated because of jet stream phenomena;right pulmonary artery dilatation rules out pulmonary valve stenosis in this patient.

    5. Guibernau says:

      X-ray shows bilateral hilar enlargement and cardiomegaly
      MRI shows
      -right chambers and left atrium growth
      -pulmonary vessels enlargement
      -communication between SCV and left atrium

      Conclusion : Left-to-right shunt


      LT to RT Shunt

    7. Ay says:

      in the paragraph above figure 5 , it is written ostium primum is most common type.
      and at dr. pepe advice: its written ostium secundum.

      I think there is a mistake.