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Case Reports
. 2011 Apr;47(1):54-6.
doi: 10.4068/cmj.2011.47.1.54. Epub 2011 Apr 26.

Masking of pressure overload in a patient with pulmonary thromboembolism accompanied by atrial septal aneurysm

Tae Kyung Yu  1 , Woo Shik Kim, Weon Kim
Affiliations
Case Reports

Masking of pressure overload in a patient with pulmonary thromboembolism accompanied by atrial septal aneurysm

Tae Kyung Yu et al. Chonnam Med J. 2011 Apr.

Abstract

A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and right-to-left shunting was detected immediately in the agitated saline test. However, definite signs of pressure overload of the right heart were not detected in the TTE. This educational case shows that right-to-left shunting via a patent foramen ovale in the ASA can cause normal right atrial pressure, thus masking the pressure overload of the right heart in a patient with PTE.

Keywords: Interatrial aneurysm; Pulmonary embolism.

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Figures

FIG. 1
FIG. 1
Chest CTA (A and B), TTE (C, D, G, and H), and TTE with agitated saline (E and F) at initial presentation and at the follow-up after 2 weeks. The initial chest CTA revealed acute PTE (large arrow in A) and the TTE showed an ASA swing from the right side to the left side (small arrows in C), and right-to-left shunting was detected immediately in the agitated saline test (E). Pulmonary artery (PA) systolic pressure calculated by maximal velocity of tricuspid regurgitation (G) and predicted RA pressure (H) was in the normal range. The follow-up CTA revealed improved PTE (B) and the TTE showed the ASA fixed to the right side (small arrows in D) and dissapearance of large quantity of right-to-left shunt (F) after 2 weeks.
See this image and copyright information in PMC

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