Case 170


A 31-year-old male patient comes to the ER after being stabbed in the third intercostal space. He was awake, alert and oriented, hemodynamically stable and had a thoracic drain. After ruling out the commitment of any other structure, he was discharged. After 2 months, was again admitted to the ER complaining of acute dyspnea, abdominal distension and pitting edema in lower limbs (++/4+). At the exam, he had a diastolic murmur at the accessory aortic area, with irradiation to the armpit, and palpable right ventricle (RV). Chest X-ray and echocardiogram showed increased pulmonary flow and RV overload, and then was submitted to cardiac catheterisation.

Based on the clinical picture and the images, which one of the following is the most likely diagnosis?

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