This is a 17 yo F who presented with fever, chest pain and weakness x 3 days. She was found to be tachycardic with poor peripheral perfusion. Her CXR was concerning for bibasilar atelectasis. Her bedside echo seen below was concerning for elevated RV pressures. The first image is an Apical 4 chamber view with slight bowing of the septum from the RV into the LV. The second image is a parasternal short axis view concerning for a D sign, where the elevated RV pressure causes flattening of the septum. The third image shows a dilated IVC.

Ultimately she was diagnosed with new onset pulmonary hypertension with presumed infective endocarditis.

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.