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An unusual finding in a 57-year-old woman with new onset hypertension and a diastolic murmur
  1. Jason M Tarkin1,
  2. James H F Rudd1,
  3. David R Jayne2,
  4. Rosemary A Rusk3,
  5. Deepa Gopalan4
  1. 1Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
  2. 2Vasculitis and Lupus Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
  3. 3Division of Cardiovascular Medicine, Cambridge University Hospitals and Papworth Hospital NHS Trust, Cambridge, UK
  4. 4Department of Radiology, Cambridge University Hospitals and Imperial College Healthcare NHS Trust, Cambridge, UK
  1. Correspondence to Dr Jason M Tarkin, Division of Cardiovascular Medicine, University of Cambridge, Box 110, Addenbrooke's Centre for Clinical Investigation, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK; jt545{at}cam.ac.uk

Abstract

Clinical introduction A 57-year-old woman presented to our clinic with breathlessness brought on while walking uphill. She had been recently diagnosed with systemic hypertension. There was no known family history of cardiac disease, or prior smoking habit. On examination, pulse was 73 bpm and blood pressure 155/73 mm Hg, which was asymmetrical in her arms. Auscultation revealed a readily audible early diastolic murmur in the aortic area and bilateral subclavian bruits. ECG showed sinus rhythm with no abnormality. Transthoracic echocardiography demonstrated mild-to-moderate aortic regurgitation, and normal left ventricular size and function. The ascending aorta was mildly dilated (41 mm), with para-aortic thickening noted. Owing to the abnormal appearance of the aortic wall, cardiac MRI, and subsequently 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scan was performed (figure 1).

Question Which complication of the underlying disease is evident in figure 1, panel C?

  1. Aortic aneurysm

  2. Aortic dissection

  3. Aortic thrombus

  4. Coronary artery aneurysm

  5. Coronary sinus fistula

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2016-309661

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    Footnotes

    • Twitter Follow James Rudd at @jhfrudd

    • Contributors JMT drafted the article. DG performed imaging. JMT, JHFR, RAR, DRJ and DG revised the article and contributed to its intellectual content.

    • Funding Wellcome Trust (104492/Z/14/Z).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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