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An unusual structure on transthoracic echocardiography
  1. Abhishek Thakur,
  2. Anish Kapil,
  3. Nirmal Ghati
  1. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Nirmal Ghati, Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India; nirmal.cmc{at}

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Clinical introduction

A man in his 50s presented to the emergency department with recurrent syncope. His medical history was notable for diabetes mellitus and hypertension. ECG showed a complete heart block with a ventricular escape rate of 30 beats per minute. Transvenous temporary pacemaker was inserted. Transthoracic echocardiography (TTE) showed severe left ventricular dilation and systolic dysfunction, ejection fraction of 30%. A modified apical four-chamber view showed an unexpected structure (figure 1, online supplemental video).

Supplementary video

Figure 1

Transthoracic echocardiogram in the apical four-chamber view with a slight anterior angulation. Unexpected finding denoted by the white arrow.


What is the structure shown in figure 1?

  1. Echogenic artefact

  2. Calcified coronary artery

  3. Retroaortic anomalous coronary artery

  4. Aortic valve calcification


C. Retroaortic anomalous coronary artery …

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  • Twitter @akapil15, @Nirmal Ghati @GhatiNirmal

  • Contributors AT and AK conceptualised the manuscript and wrote the draft. NG and AT were involved in revision of the manuscript and patient care. All the authors discussed the results and commented on the manuscript at all stages.

  • 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 and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

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