Clinical course
This prompted further investigations. A chest X-ray revealed an enlarged cardiac silhouette with prominent pulmonary trunk and pulmonary arteries proximally (Figure 2) , and the ECG revealed sinus tachycardia with right ventricular strain. An ECHO was done to confirm these findings, it revealed a dilated RA, RV and mild TR. The most notable finding was severe pulmonary artery hypertension (62 mmHg).