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Pectus excavatum with inspiratory inferior vena cava compression: a new presentation of pulsus paradoxus.

Authors
Type
Published Article
Journal
The American Journal of the Medical Sciences
0002-9629
Publisher
Elsevier
Publication Date
Volume
329
Issue
1
Pages
45–47
Identifiers
PMID: 15654179
Source
Medline
License
Unknown

Abstract

A 29-year-old man with pectus excavatum presented with exercise intolerance, pulsus paradoxus, and paradoxically split S2. Chest computed tomography (CT) showed the heart shifted leftward and a pectus severity index of 7.18. Cardiopulmonary exercise study showed reduced VO2max, anaerobic threshold, and oxygen pulse. Echocardiography revealed a decline in mitral and tricuspid valve inflow, and stroke volume during inspiration. Cardiac extrinsic compression and anatomic cardiac abnormalities were not present. Dynamic magnetic resonance imaging (MRI) demonstrated inspiratory inferior vena cava (IVC) compression at the diaphragm. We discuss IVC compression by the diaphragm as a source of patient symptoms and as a mechanism for pulsus paradoxus associated with pectus excavatum.

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