A 36 year old female presents with
progressive breathlessness. There is a history of cough and breathlessness in
childhood but no other significant past illnesses. Apart from the
contraceptive pill the patient is not on any drugs. She is married and has 3
children and is a housewife.
On examination she looked thin. Her
pulse rate is 100 beats per minute; the pulse volume is low and decreases with
inspiration. BP 100/60 JVP elevated 6 cms above the manubriosternal angle and
the height of the JVP increases with inspiration. There is no abnormality
detected on inspection of the praecordium. The apex is difficult to palpate.
The heart sounds are soft and there is an additional sound heard in mid
diastole. Lungs are clear. The liver is enlarged 4 fingerbreadths below the
costal margin, it is non-pulsatile. The patient has ascites.
In this patient which one of the
following investigations is likely to lead to a diagnosis?
Ventilation perfusion scan
CT pulmonary angiogram