Severe ACP occurred on D9 of treatment in this female patient who was mechanically ventilated because of ARDS. TEE revealed (i) right ventricular dilatation, (ii) paradoxical septal motion with right ventricular dilatation more marked at each insufflation, (iii) severe restriction of the LV as indicated by its “glove finger” appearance on the long axis, flattening on insufflation, and an inverted mitral E/A ratio, (iv) biphasic pulmonary artery flow, indicative of marked obstruction of ejection. This is ascribed to progressive deterioration in ventilatory mechanics caused by incipient pulmonary fibrosis. The patient was then given corticosteroids.
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