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Acute onset chest pain in a young man
  1. Dinkar Bhasin,
  2. Jeet Ram Kashyap,
  3. Suraj Kumar
  1. Department of Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
  1. Correspondence to Dr Jeet Ram Kashyap, Cardiology, Government Medical College and Hospital, Chandigarh, 160047, India; jeetramkashyap{at}

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Clinical introduction

A young man in his 20s presented with acute onset right-sided chest pain and dyspnoea. The patient had tachycardia, tachypnoea and markedly decreased breath sounds on the right side. The oxygen saturation was 95%. Other physical and cardiovascular examination was unremarkable. The patient had never been evaluated for any cardiorespiratory illness in the past. The chest radiograph showed right-sided pleural effusion with an underlying mass lesion. Tube thoracostomy was done and confirmed haemothorax.


Contrast-enhanced CT and contrast echocardiography were performed (figure 1). What is the diagnosis?

Figure 1

Investigations: (A) chest radiograph; (B) contrast-enhanced CT of the chest; and (C) saline contrast echocardiography.

  1. Atrial septal defect.

  2. Primary pulmonary hypertension.

  3. Partial anomalous pulmonary venous connection.

  4. Pulmonary arteriovenous malformation.

Answer: D

The …

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  • Contributors All authors contributed to design, data collection, draft preparation and review.

  • 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 and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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