Exertional dyspnoea and abnormal chest radiography

Abstract

[EN]A 75 year old woman was admitted to hospital because of dyspnoea. She had been well until nine months previously, when she started to have gradually worsening exertional dyspnoea. On admission, her physical activity was limited. She had no discomfort at rest, but even a very low level of activity caused dyspnoea. She reported no chest pain, orthopnoea, or paroxysmal nocturnal dyspnoea. She had a history of systemic hypertension. She denied smoking. Physical examination showed that she had tachypnoea and a tricuspid systolic murmur. Lung sounds were normal. Electrocardiography showed right axis deviation, right ventricular hypertrophy, and atrial fibrillation. Laboratory evaluation showed polycythaemia. Examination of her chest radiograph at admission provided clues to the diagnosis