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Why so hypoxic?
  1. Carl Byrne1,
  2. Michael Slattery2,
  3. Susan Uí Bhroin1,3
  1. 1 Emergency Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
  2. 2 Radiology Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
  3. 3 Royal College of Surgeons in Ireland, Dublin, Dublin, Ireland
  1. Correspondence to Dr Susan Uí Bhroin, Emergency Department, Our Lady of Lourdes Hospital, Drogheda, A92 VW28, Ireland; susanpower{at}

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Clinical introduction

A 35-year-old man presented to the emergency department with a 7-day history of cough and dyspnoea. At triage, his oxygen saturation was 69% on room air. His blood pressure and heart rate were normal. He has a history of congenital hypoventilation syndrome and pulmonary hypertension (PH). His chest radiograph is shown in figure 1.

Figure 1

Chest radiograph.


Which of the following is the correct diagnosis?

  1. Dilated cardiomyopathy.

  2. Pericardial effusion.

  3. Large Hiatus Hernia.

  4. Ascending aortic dissection.

Answer: (B) Pericardial effusion

The X-ray demonstrates an enlarged cardiac shadow, large enough to occupy a significant portion of the chest bilaterally. The findings are consistent …

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  • Twitter @uibhroin

  • Contributors SUB prepared the case and images, wrote the question, reviewed the report and submitted the manuscript. MS provided a radiology report for the chest radiograph. CB prepared the answers and explanation for the question.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.