Sinus Venosus Atrial Septal Defect

Abstract : A 58-year-old male was riding a horse when they were both struck by a motor vehicle. The man was thrown approximately 5 to 8 feet and suffered open comminuted fracture of the left ankle. On evaluation in the emergency department, the patient complained of chest and leg pain. His respirations were 24 per minute and his oxygen saturation on room air was 98%. His vital signs were otherwise unremarkable. A portable chest radiograph was obtained (figure 1). The patient was admitted and underwent orthopedic repair of his ankle fracture. Three days later, he developed dyspnea and non-specific chest pain. He reported symptoms of progressive shortness of breath over several years. A contrast-enhanced chest CT was performed to evaluate for pulmonary embolism (figure 2). The chest radiograph (figure 1) demonstrates increased central pulmonary vascularity (?pulmonary arterial hypertension? pattern) without evidence of pulmonary edema; the cardiac silhouette was questioned to be mildly enlarged, primarily from right heart enlargement.