Hyperlucent Lung in a Patient With Mitral Valve Disease

Abstract

A 15-year-old boy with rheumatic valvular heart disease was referred for cardiac surgery. His chief complaints were increasing shortness of breath (New York Heart Association class III) and palpitations. He was well otherwise previously. He specifically denied any significant respiratory troubles. He was receiving digoxin, furosemide, and warfarin sodium. On physical examination, he had an irregular pulse (80 beats per minute) and BP of 100/70 mm Hg. Cardiovascular examination showed an increased jugular venous pressure (9 cm above sternal angle), displaced apex to the sixth intercostal space and anterior axillary line, sustained parasternal lift, decreased intensity of S1, a loud pulmonary component of S2, an opening snap, a middiastolic murmur and a loud pansystolic murmur at the apex, and an enlarged liver (4 cm below the costal margin). Chest examination showed reduced expansion on the left side, a resonant percussion note bilaterally, markedly reduced breath sounds on the left side, and fine basal crackles on the right side.