Man With Respiratory Distress and Facial Swelling

Abstract

A 21-year-old man was discharged uneventfully after a motorcycle crash 2 months ago and re-presented to the emergency department after 24 hours of worsening respiratory distress and facial and neck swelling. The physician auscultated a new 3/6 systolic murmur at the left lower sternal border, and echocardiography revealed massive tricuspid regurgitation with a freely floating papillary muscle attached to the anterior leaflet (Figure 1 and Video E1). Computed tomographic scan ruled out vena cava abnormality or pulmonary embolus.