Eisenmenger syndrome with patent ductus arteriosus (PDA)

Development of Eisenmenger syndrome in a known patient of patent ductus arteriosus (PDA) is easy by carefully looking for differential cyanosis and clubbing in upper and lower limbs. It is quite uncommon for a patient of PDA to present primarily after development of Eisenmenger syndrome. We report a 35-year-old male who presented in chest outpatient department (OPD) with hemoptysis and was sent to us for routine echocardiography. On screening transthoracic echocardiography (TTE), right atrium (RA) and right ventricular (RV) were enlarged with severe tricuspid regurgitation (TR) and intact IAS and IVS without pulmonary stenosis and normal RV ejection fraction. It could have been concluded that it is a case of primary pulmonary hypertension but agitated saline injected in upper extremity was done just as a routine. On contrast echocardiography, in suprasternal notch view agitated saline was seen in pulmonary artery and then filling the descending aorta before ascending aorta. This agitated saline contrast established diagnosis of PDA with Eisenmenger syndrome.