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Image challenge
Asymptomatic young man with an incidental murmur
  1. Maryam Shojaeifard1,
  2. Hamid Reza Pouraliakbar2,
  3. Golnaz Houshmand1
  1. 1 Echocardiography Department, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
  2. 2 Imaging Department, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
  1. Correspondence to Dr Golnaz Houshmand, Echocardiography Department, Rajaie Cardiovascular Medical and Research Center, Tehran, 1661753441, Iran (the Islamic Republic of); golhoush{at}gmail.com

Abstract

Clinical introduction A 32-year old man was referred to our institution for transthoracic echocardiography (TTE) following detection of an incidental murmur on physical examination before blood donation. He was asymptomatic with no significant medical history. Physical examination revealed dual heart sounds with a grade II/VI systolic murmur heard in the left sternal border. An ECG was in normal sinus rhythm. TTE was performed (figure 1A–C, online supplementary videos 1–4) followed by cardiac CT angiography (CTA) (figure 1D,E).

Figure 1
Figure 1

(A) Transthoracic echocardiography, parasternal left ventricular long axis view. (B) Colour Doppler of modified short axis in the mid-left ventricular level. (C) Doppler flow velocity profile. (D) Cardiac CT angiography (CTA) sagittal reconstruction. (E) Three-dimensional CTA reconstruction of the heart.

Question What is the diagnosis?

  1. Pericardial cyst.

  2. Ventricular septal defect.

  3. Kawasaki.

  4. Anomalous left coronary artery from pulmonary artery (ALCAPA).

  • echocardiography
  • congenital heart disease
  • cardiac imaging and diagnostics
  • cardiac computer tomographic (ct) imaging

http://dx.doi.org/10.1136/heartjnl-2018-313223

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    Footnotes

    • Contributors All authors have substantial contribution to the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the Ethics Committee of Shaheed Rajaie Cardiovascular Medical and Research Center.

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