Medical image of the week: Eisenmenger syndrome and hemoptysis

No abstract available. Article truncated after 150 words. A 26 year-old female with Eisenmenger syndrome presented with hemoptysis. An echocardiogram showed an enlarged right ventricle and two large mid-muscular ventricular septal defects (VSD) with right to left shunting (Figures 1 and 2). A contrast enhanced CT of the chest showed an enlarged pulmonary artery, no evidence of pulmonary embolism and the VSDs (Figure 3 and 4). Eisenmenger syndrome is a condition in which increased pulmonary blood flow secondary to a left to right intracardiac shunt leads to irreversible pulmonary vascular obstructive disease. The resultant high pulmonary vascular resistance causes reversal and right to left intracardiac shunt. Hemoptysis is a common complication of Eisenmenger syndrome and has been reported as the cause of death in 11-29% of patients. It can be caused by pulmonary artery thrombosis, pulmonary embolism, rupture of aortopulmonary collaterals, pulmonary artery dissection and hemorrhage due to an aneurysm or thin-walled arterioles, infectious sources or a bleeding