A 48-year-old man presented with progressive shortness of breath, productive cough, and swelling of both lower limbs. On arrival, he was in significant respiratory distress and required mechanical ventilation in the intensive care unit. His blood pressure was 90/50 mmHg, and jugular venous pressure was markedly elevated.
Physical assessment revealed a deformed chest wall with pectus excavatum and thoracic scoliosis. Coarse crackles were audible throughout both lung fields.
A bedside cardiac ultrasound performed with the Evamed Handheld Ultrasound Scanner demonstrated pronounced enlargement of the right atrium and right ventricle. The interventricular septum displayed a characteristic D-shaped configuration, indicating severe pulmonary hypertension. There was also marked tricuspid regurgitation. The inferior vena cava appeared plethoric and showed minimal respiratory variation, suggesting elevated right atrial pressure.
