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Right ventricle dilatation: the big five
  1. Rene Jansen van Rensburg1,2,
  2. Anton Frans Doubell3,4,
  3. Philipus George Herbst3,4
  1. 1 Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
  2. 2 Department of Medicine, Tygerberg Hospital, Cape Town, Western Cape, South Africa
  3. 3 Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, Western Cape, South Africa
  4. 4 Division of Cardiology, Department of Medicine, Tygerberg Hospital, Cape Town, Western Cape, South Africa
  1. Correspondence to Dr Rene Jansen van Rensburg, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa; renejvr1{at}gmail.com

https://doi.org/10.1136/heartjnl-2019-315945

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    Clinical introduction

    A 38-year-old man, previously well, presents after being mauled by a Cape buffalo, while on Safari in South Africa. He recovered well but visited a cardiologist for infrequent palpitations lasting less than 10 min. A chest radiograph demonstrated increased cardiothoracic ratio raising the concern of possible traumatic mediastinal injury. His clinical examination was unremarkable.

    ECG demonstrated sinus rhythm with incomplete right bundle branch block.

    Echocardiography revealed a dilated, hyperdynamic right ventricle (RV) and dilated coronary sinus (CS). The left ventricle (LV) and aorta were normal with no evidence of aneurysm or dissection.

    An agitated saline bubble study was performed via the left antecubital fossa. Interestingly, all bubbles entered the right atrium (RA) via the superior vena cava (SVC) with no bubbles entering via the CS and no bubbles shunting to the left …

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    Footnotes

    • Contributors All authors contributed to this 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 for publication Obtained.

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