Pink tetralogy of Fallot
Uncorrected adult tetralogy of Fallot is rare.
This patient had periods of high oxygen demand in the emergency requirement and was noted to have polycythemia as well as a heart murmur.
Pink Tetralogy of Fallot occurs because the degree of right ventricular outflow obstruction is minimal and does not result in a right to left shunt (therefore acyanotic).
The chronic hypoxia causes the acquired / secondary polycythemia.
The patient underwent an outpatient correctional procedure for the cardiac anomaly including a pulmonary valve replacement, patch augmentation of the main pulmonary artery and right ventricular outflow tract.
Case with thanks to Corey Thompson.