Fatigue, Weight Loss, and Anorexia
The patient is a 37-year-old man with fatigue, a 20-1b weight loss, and worsening anorexia over the past 6 months.
 Figure 18-1. |
 Figure 18-2. |
 Figure 18-3. |
QUESTION 1. A saline contrast bubble study was ordered to evaluate for a patent foramen ovale (PFO). Saline contrast was injected into the right arm.
In Figure 18-1 and Video 18-1, what do you see?
A. A right-to-left shunt consistent with a PFO
B. A ventricular septal defect
C. An atrial septal defect
D. Saline contrast entering the left atrium before the right atrium
View Answer
ANSWER 1: D. Saline contrast enters the left atrium before saline contrast is seen in the right atrium.
QUESTION 2. Based on the M-mode inferior vena cava (IVC) findings (Fig. 18-2), the right atrial pressure is:
A. Normal
B. Elevated
C. Low
View Answer
ANSWER 2: B. Right atrial pressure is elevated, as there is no inspiratory decrease in IVC size.
QUESTION 3. The spectral Doppler (Fig. 18-3) shows:
A. An increased diastolic gradient across the tricuspid valve
B. Tricuspid regurgitation
C. Pulmonic stenosis
D. Findings consistent with carcinoid syndrome
View Answer
ANSWER 3: A. The spectral Doppler shows an increased diastolic gradient across the tricuspid valve.
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