A 63-year-old lady presented with breath lessness of over five weeks. Lung perfusion scan illustrated bilateral mismatched perfusion defects consistent with multiple pulmonary emboli. Six months later, the patient presented with dyspnoea and was assessed for ischaemic heart disease with a myocardial perfusion SPECT scan. The scan images did not show any evidence of ischaemia or infarction. However, the scan showed prominent right ventricular uptake and a D-shaped left ventricle (Movahed's sign). Repeat perfusion lung scan demonstrated persistent bilateral pumonary embolism. Echocardiogram confirmed marked right heart enlargement, significant pulmonary hypertension with pulmonary artery pressure in excess of 80 mmHg. This case illustrates diagnostic value of left ventricular shape on a myocardial perfusion scan.
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