BMJ Case Reports 2012; doi:10.1136/bcr.03.2012.6095
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Unilateral inverse moustache sign

  1. Lorraine Simone Dias3
  1. 1Cardiology Department, Kasturba Medical College, Manipal, Karnataka, India
  2. 2Cardiology Department, MCOAHS, Manipal, Karnataka, India
  3. 3Internal Medicine Department, Kasturba Medical College, Manipal, Karnataka, India
  1. Correspondence to Dr G Vivek, vivekgraman{at}


A 54-year-old lady was admitted with breathlessness since 2 months (NYHA class 3). She was previously diagnosed to have rheumatic heart disease (RHD), but was not on any medications. Her chest radiograph revealed evidence of main pulmonary artery dilatation and unilateral upper lobe venous prominence (cephalisation) on the right side (figure 1A). Echocardiogram showed partial anomalous pulmonary venous connection (PAPVC) of the left upper pulmonary vein to the left innominate vein via a vertical vein (figure 1B). In addition, chronic RHD with severe mitral stenosis (MS) with mitral valve …

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