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A Man Aged 45 Years With Chinese Dragon Sign on Chest Radiography

To identify the key insights or developments described in this article
1 Credit CME

A man aged 45 years presented with progressive shortness of breath and peripheral edema. Physical examination revealed diffusely decreased breath sounds with signs of respiratory distress, peripheral cyanosis, and anasarca. Chest radiography was performed (Figure) and showed evidence of surgical aortic valve replacement and tricuspid valve repair by annuloplasty. There was also evidence of severe coronary disease with ischemic cardiomyopathy, left ventricular ejection fraction less than 35%, and prolonged QRS complex greater than 150 milliseconds as evidenced by the presence of a biventricular pacemaker defibrillator. The patient had end-stage kidney disease requiring hemodialysis and a prior gastrointestinal bleed necessitating gastric clipping. The Chinese dragon sign was present on radiography, which signifies a calcified splenic artery. This sign is typically seen in patients with diabetes and older patients.1 The presence of the subcutaneous defibrillator indicates that this patient may have had infective endocarditis or cardiomyopathy at a young age.2 As the patient was acutely ill, he was placed on a ventilator and given nutrition via nasogastric tube. The patient was treated for acute systolic heart failure with hemodialysis for volume removal.

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Article Information

Published Online: May 24, 2023. doi:10.1001/jamacardio.2023.1104

Corresponding Author: Damian Valencia, MD, Department of Cardiovascular Medicine, Kettering Health, Main Campus, 3535 Southern Blvd, Kettering, OH 45429 (damian.valencia@ketteringhealth.org).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Ramanathan  S .  Chinese dragon sign: splenic artery calcification.   Abdom Radiol (NY). 2019;44(8):2945-2946. doi:10.1007/s00261-019-02054-8PubMedGoogle ScholarCrossref
2.
Orgeron  GM , Bhonsale  A , Migliore  F ,  et al.  Subcutaneous implantable cardioverter-defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia: a transatlantic experience.   J Am Heart Assoc. 2018;7(21):e008782. doi:10.1161/JAHA.118.008782PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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