A 47-year-old lady presented with dyspnea, cough and purulent sputum. She was receiving regular inhaler b-agonist and corticosteroids with the diagnosis of asthma bronchial since childhood. She had history of very often upper and lower respiratory tract infections. She did not smoke, drink alcohol, or use illicit drugs intravenously. Physical examination revealed the patient had central cyanosis, pretibial edema and her lung sounds were decreased to auscultation bilaterally with deep inspiration.
In cardiac auscultation, the heart sounds were heard at the right of sternum and there was splitting in second heart sound (S2). ECG demonstrated sinus tachycardia, inversion of the P and T wave in lead 1 with loss of R wave progression and p pulmonale. Images for chest x-ray (image 1) and Paranasal sinus CT (image 2) are attached. Routine complete blood test revealed- Mild leukocytosis …
