Pectus excavatum with inspiratory inferior vena cava compression: A new presentation of Pulsus paradoxus

Kishore Yalamanchili, Warren Summer, Vincent Valentine

Research output: Contribution to journalArticle

13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)45-47
Number of pages3
JournalAmerican Journal of the Medical Sciences
Volume329
Issue number1
DOIs
StatePublished - Jan 2005

Keywords

  • Inferior vena cava
  • Inspiration
  • Pectus excavatum
  • Pulsus paradoxus
  • Stroke volume

ASJC Scopus subject areas

  • Medicine(all)

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