Immersion pulmonary oedema in a triathlete – a diagnostic challenge in sports cardiology

Figures

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  Fig. 1.. Chest radiography findings at three different time points during the period of patient care. A. Examination performed in the emergency department (Day 0) – marked parenchymal changes involving the middle and lower lung fields. B. Another day of hospitalisation (Day 3) – clear regression of parenchymal lesions. C. Long-term evaluation after the original incident (Day 30) – complete resolution of parenchymal lesions

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  Fig. 2.. Chest CT scan dedicated to the assessment of pulmonary parenchyma – high-resolution computed tomography (HRCT) (A). Comparative concurrent lung ultrasound examination performed with a linear transducer (B, C). A. CT scan revealing extensive ground-glass parenchymal opacities. B, C. Lung ultrasound showing diffuse B-lines. The red arrowhead shows the approximate location where the linear was applied. A clear correlation is seen between B-lines and ground-glass opacities

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  Fig. 3.. Echocardiographic evaluation. A, C. Evaluation of the right and left ventricular relations at different time points during the period of patient care; a marked change in the ratio between the right and the left ventricle areas (RVS/LVA) over several days of follow-up (Day 1 vs Day 30) is noted. B, D. Assessment of right ventricular systolic function by tracking acoustic markers; compared to the baseline image (Day 0), there is a marked improvement in right ventricular free-wall longitudinal strain (Day 30). RV – right ventricle; LV – left ventricle; RVA – right ventricle area; LVA – left ventricle area

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  Fig. 4.. Assessment of myocardial perfusion by SPECT – rest and stress tests showing no significant ischaemia. Top bar: stress–rest cross-section images in the short axis; middle bar: stress–rest horizontal cross-section images in the long axis; bottom bar: stress–rest vertical cross-section images in the short axis. SA – short axis, VLA – vertical long axis, HLA – horizontal long axis

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  Fig. 5.. Cardiac imaging using 99mTc-methoxy-isobutyl-isonitrile; 3D-Gated display. A. At stress. B. At rest. C. No difference between rest and stress tests