The diagnosis of patent ductus arteriosus with Eisenmenger's syndrome by three-dimensional computed tomography: A case report

Abstract

The diagnosis of patent ductus arteriosus (PDA) with left-to-right shunt can be made on the basis of transthoracic echocardiographic examination [1]. However, the diagnosis of PDA with right-to-left shunt by using transthoracic echocardiography is difficult because of the lack of typical color flow associated with PDA [2]. In this report, we describe the utility of 3-dimensional computed tomography (CT) to demonstrate presence of PDA in a patient with suspected PDA with Eissenmenger’s syndrome. A 47-year-old woman was admitted to our department with dyspnea on exertion for 32 years. Patient’s vital signs were normal. On physical examination, an intense second heart sound on the pulmonary area and a grade 3/6 pansystolic murmur on the pulmonary, tricuspid and mesocardiac areas were auscultated. The patient’s jugular veins were distended at approximately 15 cm H2O. Both her feet and left hand were cyanotic, and lower extremities had bilateral 1+ pitting edema. The electrocardiogram showed right axis, right bundle branch block, right ventricular hypertrophy and biatrial enlargement. The chest radiography demonstrated moderate cardiomegaly, prominent pulmonary arterial conus and calcification between aortic and pulmonary arch. Transthoracic echocardiogram revealed right ventricular hypertrophy and dilatation, pulmonary arterial and biatrial dilatation, elevated pulmonary arterial pressure (systolic pressure was 120 mmHg). No congenital cardiac abnormalities were seen. According to finger pulse