Misleading echocardiographic artifact mimicking severe pulmonary hypertension in a pregnant woman: A diagnostic challenge

Background: Echocardiographic artifacts can lead to significant diagnostic errors, potentially resulting in unnecessary medical interventions. Accurate interpretation of echocardiographic findings is particularly critical in pregnancy, where misdiagnosis of pulmonary hypertension (PH) can have serious implications. Case presentation: We present the case of a 28-year-old pregnant woman initially diagnosed with severe PH based on transthoracic echocardiography (TTE). The high tricuspid regurgitation velocity (TRV) suggested severe PH, raising concerns about pregnancy continuation. However, a comprehensive echocardiographic reassessment identified the finding as an aliasing artifact caused by a medially directed aortic insufficiency (AI) jet. A detailed Doppler analysis revealed that the high-velocity signal obtained in the tricuspid valve region occurred during diastole rather than systole, confirming the artifact. The high-velocity flow mistakenly interpreted as a systolic tricuspid regurgitation (TR) jet was actually an aliasing of a diastolic AI jet, which was accidently parallel to the TR flow. With the correct diagnosis established, the patient was reassured and successfully carried her pregnancy to term without complications. Conclusion: This case underscores the importance of recognizing echocardiographic artifacts and pitfalls to avoid misdiagnosis. Misinterpretation of echocardiographic findings can lead to unnecessary clinical decisions, emphasizing the need for advanced echocardiographic training and careful consideration of diagnostic limitations, especially in high-risk populations.