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Images in Thorax
Double whammy: the disappearing right atrium
  1. Aparna Kadambi,
  2. Parimal Kumar Chaudhari,
  3. Lawrence DeLorenzo,
  4. Oleg Epelbaum
  1. Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
  1. Correspondence to Dr Aparna Kadambi, Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center at New York Medical College, 100 woods road, Valhalla, New York 10595, USA; draparnakadambi{at}gmail.com

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A 66-year-old man with hepatitis C virus (HCV) infection complicated by liver cirrhosis presented with about 6 months of severe right shoulder pain as well as more recent progressive dyspnoea on exertion and lower extremity oedema. On outpatient evaluation at the onset of shoulder symptoms, they had been ascribed to an orthopaedic aetiology. He had recently completed treatment for HCV with ledipasvir/sofosbuvir after failure to respond to a regimen of interferon/ribavirin. Approximately 2 years earlier, he had been diagnosed with unresectable multifocal stage III hepatocellular carcinoma (HCC) and treated with transarterial chemoembolisation (TACE), radiofrequency ablation and ethanol ablation as a bridge to possible liver transplantation. On presentation, he was hemodynamically stable with no reported pulsus paradoxus. Physical examination revealed an elevated jugular venous pulse, anasarca and decreased breath sounds over the right lower chest. There was no clinically overt ascites. His plain chest radiograph showed a right pleural effusion and a thickened right …

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