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In the apical four chamber view the right ventricle in a normal patient should have a diameter that is less than the diameter of the left ventricle. This patient with pulmonary hypertension has an RV that is clearly larger. In addition, the intraventricular septum can be see moving into the left ventricle during diastole, a finding call paradoxical septal motion. The right atrium can also be seen to be enlarged. In the RV, the echogenic structure is the moderator band, not a thrombus.