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Image challenge
Young man with chest pain and an abnormal echocardiogram
  1. Matthew Peters,
  2. Dinesh Kalra
  1. University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Dr Dinesh Kalra, University of Louisville, Louisville, KY 40202, USA; dinesh.kalra{at}louisville.edu

https://doi.org/10.1136/heartjnl-2024-323886

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    Clinical introduction

    A man in his 40s with a history of hyperlipidaemia presented with intermittent, dull left-sided chest pain for 2 weeks that was not consistently exertional. He denied dyspnoea, cough, fevers, recent travel or exposure to sick people. He did not smoke or use alcohol or illicit drugs. There was no pertinent family history. Physical examination, an ECG, basic laboratories and a chest X-ray were unremarkable. The patient was referred for an exercise nuclear study and did 11 min on the Bruce protocol without angina or ischaemic ECG changes. Myocardial scintigraphic perfusion images at stress and rest were normal. A transthoracic echocardiogram was performed (figure 1).

    Figure 1

    Transthoracic echocardiogram ((A) apical four-chamber view; (B) parasternal short-axis view).

    Question

    What is the most likely diagnosis?

    1. Aortic dissection

    2. Sinus of Valsalva aneurysm

    3. Anomalous coronary artery

    4. Unroofed coronary sinus type of atrial septal defect

    Answer: C

    The echocardiogram shows the presence of an anomalous, retroaortic coronary artery sign (sensitivity 63%, specificity 94%) (figure 2A,B; …

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    Footnotes

    • X @DineshKalra

    • Contributors Both authors fully contributed to conception, drafting and editing the manuscript.

    • 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.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.