Article Text

Download PDFPDF
Image challenge
Fourteen-year-old boy with decreased appetite and pedal swelling
  1. Gopal Chandra Ghosh1,
  2. Aparna S2,
  3. Oomen K George3
  1. 1 Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
  2. 2 Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
  3. 3 Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Gopal Chandra Ghosh, Department of Cardiology, Christian Medical College, Vellore-632004, India; gcghosh86{at}


Clinical introduction A 14-year-old boy presented with history of decreased appetite and bilateral swelling of feet for 6 months. He did not give any associated history of orthopnoea or paroxysmal nocturnal dyspnoea. He was born by a normal delivery after a non-consanguineous marriage. He had an unremarkable birth and childhood health history. There was no family history of significant cardiovascular illness or sudden death. Clinical examination showed an average built boy with elevated jugular venous pressure with prominent v wave and bilateral pitting pedal oedema. Cardiovascular examination showed normal first (S1) and second (S2) heart sounds and a short early systolic murmur over tricuspid region. Other systems examination was remarkable for soft tender hepatomegaly.

ECG showed sinus rhythm with tall, peaked p waves. Chest X-ray revealed enlargement along the right cardiac border. Transthoracic echocardiographic images are shown in figure 1A (apical four-chamber view) and figure 1B (tricuspid inflow Doppler). There was no colour Doppler evidence of interatrial shunt.

Figure 1

(A) Transthoracic echocardiographic apical four-chamber view. (B) Tricuspid inflow continuous wave Doppler image.

Question What is the most likely diagnosis of his condition?

  1. Endomyocardial fibrosis (EMF)

  2. Ebstein’s anomaly

  3. Arrhythmogenic right ventricular dysplasia (ARVD)

  4. Idiopathic dilatation of right atrium

  5. Restrictive cardiomyopathy

  • cardiac imaging and diagnostics
  • echocardiography
  • myocardial disease
  • medical education

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors GCG was involved in writing, editing and management of the patient. AS was involved in editing the writing of the manuscript. OKG was involved in the management of the patient and overall supervision of writing the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.