Focal posterior left atrial turbulence as a sign of pulmonary venous obstruction
Two-dimensional and Doppler ultrasonography of a patient with pulmonary hypertension due to histoplasmosis-induced fibrosis mediastinitis with resultant pulmonary venous obstruction revealed focal posterior left atrial turbulence, as well as evidence of right ventricular pressure and volume overload. Careful localization of the flow disturbance allowed exclusion of other causes of left atrial turbulence, such as mitral regurgitation, atrial septal defect, and cor triatriatum, thereby identifying the hemodynamic abnormality of pulmonary venous obstruction as the primary hemodynamic abnormality. Thus, the echocardiographic examination of patients with pulmonary hypertension and elevated pulmonary capillary wedge pressure should include a careful Doppler examination of pulmonary venous outflow.
