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A 49 year old man was admitted to our hospital because of exertional dyspnoea and chest discomfort. On admission, physical examination revealed a grade 2/6 systolic ejection murmur that was most prominent at the second intercostal space along the left sternal border. An echocardiogram demonstrated an aneurysm originating from the base of the aorta. Because the wall of the aneurysm wall was thin, it was difficult to detect it by two dimensional echocardiogram. Colour Doppler imaging showed the flow moving from the aorta inside the aneurysm and hyperdynamic flow towards the pulmonary artery, which was split by the aneurysm. Magnetic resonance images (MRI) revealed an aneurysm of the sinus of Valsalva originating from the right cusp, 20 × 18 m in size and obstructing the right ventricular outflow tract (RVOT) (below). An aortogram (right, A, B) and right ventriculogram (C, D) confirmed an aneurysm of the sinus of Valsalva in the RVOT. The aneurysm is visualised by aortogram and the defect in the contrast is shown in the right ventriculogram (arrow).
In this case, it was of particular interest that MRI was useful to demonstrate the structural relation between the aneurysm and surrounding cardiovascular organs.