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A 19 year old woman was admitted with cough, dyspnoea, pleuritic chest pain, tachycardia, and hypoxia 20 weeks after the birth of her first child. Chest x ray findings were unremarkable. Echocardiography (panel A) revealed pronounced right ventricular dilatation, severe tricuspid regurgitation, and a right ventricular systolic pressure of 70 mm Hg. Initially pulmonary embolism was suspected. Computed tomographic (CT) pulmonary angiography, however, showed no evidence of pulmonary embolism although high resolution CT images revealed diffuse bilateral air space shadowing (panel B). Avian proteins antibodies were strongly positive and on further questioning the patient admitted to keeping over 50 parakeets in her home. Her right ventricular dilatation and pulmonary hypertension resolved following steroid treatment. In summary, extrinsic allergic alveolitis is a rare but important cause of right ventricular dilatation and pulmonary hypertension.
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