Endgames Case Review

Patent ductus arteriosus illuminating an old eponym

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2182 (Published 06 May 2016) Cite this as: BMJ 2016;353:i2182
  1. Tom Ford, cardiology registrar1 2,
  2. David Rees, consultant cardiologist1 2
  1. 1Department of Cardiology, St George Hospital, Sydney, NSW, Australia
  2. 2School of Medicine, University of New South Wales, NSW, Australia
  1. Correspondence to: T Ford thomasjford{at}gmail.com

A 60 year old woman was sent from primary care for assessment of acute left sided pleuritic chest pain and dyspnoea without sputum production. She had been experiencing malaise, intermittent fever, and rigors for four weeks. A patent ductus arteriosus (PDA) had been identified in late adulthood 10 years earlier, after a murmur was detected on routine medical examination. This was confirmed by transthoracic echocardiography; there were no other signs of haemodynamic importance.

At presentation she had a fever (39.0°C) with left sided pleural rub. Precordial examination identified a continuous “machinery” murmur. Electrocardiographic findings were within normal limits and laboratory investigations confirmed normocytic anaemia, leucocytosis, and preserved renal function. Group B streptococcus was isolated from all three separate blood cultures. Her pleural rub corresponded to an abnormality on chest radiography (fig 1).

Fig 1

Questions

  1. What abnormality on chest radiography corresponds to the pleural rub?

  2. Given the clinical presentation and history of PDA, what is the likely cause of this abnormality?

  3. What investigation would confirm the cause of this abnormality?

  4. What is the initial cardiac imaging technique of choice?

Answers

1. What abnormality on chest radiography corresponds to the pleural rub?

Short answer

The wedge shaped peripherally based opacity in the left mid zone.

Discussion

The triangular (wedge) shaped opacity in the left mid zone (fig 2) corresponds to the clinical history of left sided pleuritic pain and examination finding of a pleural rub. Such a wedge shaped opacity is eponymously termed “Hampton’s hump”—an old but important plain radiological sign of pulmonary embolism. It was first described in 1940 by the radiologist Aubrey Otis Hampton.1 On close inspection of the enlarged radiograph, smaller scattered opacities …

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