A 27-year-old woman is admitted with cough, shoness of breath, and palpitations. She has been relatively well for most of her life, but her mother gives a history that the patient had recurrent "pneumonia" as a child. The patient denies any sputum production. On examination, she appears anxious. Her neck veins are distended and she has a widened split second hea sound with little respiratory variation. A systolic ejection murmur in the pulmonic area is noted. Lung exam reveals bilateral crackles; mild ascites and pedal edema are also noted. EKG shows right axis detion. CXR is shown in.. The next diagnostic step is
CT scan of the chest Immunoglobulin levels PPD testing Echocardiogram