Presentation
Hemoptysis, dyspnea, syncope.
Patient Data
The heart is enlarged. The tip of the right-sided CVC line is in the SVC.
Disproportionately enlarged proximal pulmonary arteries and oligemia in the left lower zone.
Left retro-cardiac opacification.
The left costophrenic angle is obscured.
Thoracic spondylotic changes and scoliosis concave to the left.
Conclusion:
cardiomegaly
abnormal pulmonary vessels
pulmonary opacity in the medial left lower zone
Left ventricle: Normal-sized cavity. There is no thrombus. There is mild left ventricular wall hypertrophy. Preserved global systolic function. Grade 1 diastolic dysfunction, impaired relaxation pattern.
Right ventricle: Dilated, RV basal diameter 5.5cm, hypokinetic with impaired longitudinal function (TAPSE 1.3 cm) and basal systolic function (TDI S' 7.7 cm/s).
Flattening of the interventricular septum (D-shaped left ventricle) secondary to right ventricle overload and increased pressure. Severe tricuspid regurgitation with severely elevated pulmonary pressures. Estimated sPAP 68 mmHg.
Atria: biatrial dilatation, no masses or thrombi.
Aorta: no intimal flaps or dilation evident.
IVC: dilated (2.3 cm) with >50% inspirational collapse.
Pericardium: mild pericardial effusion
Conclusion:
Echo findings consistent with Cor pulmonale
Extensive occlusive and non-occlusive pulmonary emboli.
Oligaemic left lower lobe.
Occlusion of the left posteromedial basal bronchus with distal collapse and consolidation.
Moderate bilateral pleural effusions.
Dilated right heart chambers and main pulmonary artery.
Hiatal hernia transmitting part of the stomach.
Conclusion:
Extensive pulmonary thrombo-embolism and right heart dilatation.
Case Discussion
Cor pulmonale is defined as an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system such as chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF). Pulmonary embolic disease is often included in this classification and also causes pulmonary hypertension.
Echocardiographic evaluation is an important tool in the diagnosis and the prognostic stratification of patients with cor pulmonale.
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