title: An unexpected cause of right heart strain.
abstract: A 27-year-old woman was referred from her general practitioner (GP) 6 weeks postpartum with weight loss, dyspnoea and bilateral leg swelling. She had been treated by the GP for a chest infection the week before. On admission she was tachycardic, hypotensive and hypoxic with bilateral leg oedema and bibasal crackles. A chest radiograph showed diffuse multinodular opacification. A CT pulmonary angiogram showed dilated pulmonary artery. Echocardiogram confirmed right ventricular strain and dilation. Sputum microscopy was positive for acid-fast bacilli. The patient developed confusion and low-grade fever and the CT head scan showed meningeal involvement. One year of antituberculous therapy was started and she made a clinical recovery after 10 days and was discharged with regular follow-up. An echocardiogram showed resolution of the right heart strain 4 months later.
authors.affiliation: Whipps Cross Hospital, London, UK. aarash.saleh@nhs.net
authors.forename: Aarash
authors.initials: A
authors.lastname: Saleh
authors.forename: Ali A
authors.initials: AA
authors.lastname: Mohammed
authors.forename: Phil
authors.initials: P
authors.lastname: Raines
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D011660:Pulmonary Heart Disease / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014391:Tuberculosis, Miliary / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging