Article Text

Asymptomatic young man with an incidental murmur


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

(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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.