Clinical introduction A 63-year-old man with HIV presented with 1 month of dyspnoea and productive cough without orthopnoea. He was afebrile with normal blood pressure, borderline tachycardia and mild pulmonary wheezing. He had exertional hypoxia requiring 4 L per minute of oxygen. No murmurs, jugular venous distention or lower extremity oedema was noted. Clinical evaluation included transthoracic echocardiography (TTE), which showed mild left ventricular hypertrophy with normal size and systolic function. The right ventricle was normal. There was mild aortic insufficiency; other valves were normal. An abnormality was incidentally seen at the aortic root.
The patient was treated for bronchitis and chronic obstructive pulmonary disease exacerbation, while further evaluation of the incidental aortic root finding was performed with transoesophageal echocardiography (TEE) and cardiac MRI (CMR).
Question What is the most likely diagnosis for this finding?
Sinus of Valsalva aneurysm.
Chronic aortic dissection.
Left ventricular outflow tract (LVOT) pseudoaneurysm.
Right coronary artery aneurysm.
Aortic root abscess.
- cardiac magnetic resonance (cmr) imaging
- aortic and arterial disease
- cardiac surgery
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Contributors AJB was responsible for drafting the manuscript and selecting candidate images for inclusion. JFL and ADC contributed revisions to the text for content and style. They also provided input on image selection. All authors have reviewed the manuscript in its final form.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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