Abstract
A 9-year-old girl was admitted to the hospital because of exertional dyspnea, intermittent fever and fatigue, and inappetence for 3 months. She did not have chills or night sweats and had not lost weight. She was in mild respiratory distress with a respiratory rate of 34 breaths/min and a heart rate of 100 bpm that was regular in rhythm. Her blood pressure was 94/62 mm Hg. Cardiac auscultation revealed a distinct early diastolic click followed by a grade 2/5 diastolic decrescendo murmur at the apex that was variable in character with postural changes. Chest x-ray, posterior-anterior view, showed that the cardiothoracic ratio was increased. A high density was noted behind heart. The left lateral view showed an enlarged left atrium and abnormally high density at the region of lower left pulmonary hilar (Figure 1). Figure 1. Chest x-ray. A , Posterior-anterior view showed that the cardiothoracic ratio was increased, and a high density was noted behind the heart (arrow). B , Left lateral view showed an enlarged left atrium and an abnormally high density (arrow) at the region of the lower left pulmonary hilar. The ECG showed sinus rhythm, left atrium enlargement demonstrated by bifid P wave with >40 milliseconds between the 2 peaks and a total P-wave duration of >110 milliseconds in lead II. A biphasic P wave was seen with a terminal negative portion that was >40 milliseconds in duration and …
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