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

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.