Cardiomegaly - atrial septal defect
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Shortness of breath and palpitation.
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Chest radiograph reveals cardiomegaly with prominent pulmonary conus and enlargement of bilateral hilar pulmonary vessels.
Lung zones appear clear. The trachea is central in position. Major bronchi are normal. Bilateral costophrenic angles are clear. The bony thorax is normal.
The patient underwent echocardiography which revealed:
- ostium secundum type atrial septal defect of about 4.3 cm showing left to right shunting of blood
- dilated right atrium, right ventricle, and left atrium
- preserved left ventricular systolic function (ejection fraction of ~55%)
- moderate pulmonary artery hypertension (pulmonary artery systolic pressure of 40 mmHg) ostium secundum defect in the region of interatrial septum with the enlarged right atrium
An atrial septal defect is one of the most common congenital heart diseases encountered in adulthood. This case demonstrates the typical features of the atrial septal defect with consequent dilatation of right atrium and right ventricle leading to pulmonary hypertension.