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Quiz: Imaging

A patient with heart failure symptoms and continuous murmur

A 65-year-old man was admitted to hospital having dyspnea, fatigue, edema of both legs. Heart failure symptoms worsened during the last couple of weeks. He had long-standing arterial hypertension with poor control of arterial pressure without symptoms of coronary artery disease. Electrocardiogram showed sinus rhythm and left bundle branch block. Precordial auscultation revealed a loud continuous murmur. Laboratory findings were unremarkable. Images (Fig. 1 – 4) were recorded during transthoracic echocardiography. Echocardiography showed left ventricular walls hypertrophy, normal systolic ventricular function, and moderate right ventricular dilatation.

Figure  1. Echocardiography. Parasternal long-axis view. Colour Doppler echocardiography of turbulent flow in the right ventricle

Figure  2. Echocardiography. Parasternal long-axis view. Echo-lucent cavity close to the right side of the interventricular septum

 

 

Figure 3. Echocardiography. Parasternal short-axis view. Color Doppler echocardiography of the turbulent flow

 

 

Figure  4. Continuous-wave Doppler of the turbulent flow in the right ventricle

 

The differential diagnosis and which of the following is the correct answer:

 

1.Congenital ventricular septal defect with interventricular septum aneurysm

2.Postinfarction ventricular septal rupture

3.Ruptured sinus of Valsalva aneurysm,

4.Right coronary artery aneurysm

5.Coronary artery-right ventricular fistula

 

Nelya Oryshchyn, Yuriy Ivaniv

Department of Diagnostic Radiology

Danylo Halytsky National Medical University, Lviv, Ukraine

Ethics: Informed consent was obtained from patient before procedures

Peer-review: Internal and external

Conflict of interest: None to declare

Authorship: N.O. and Y.I. equally contributed to case management  and preparation of manuscript

                            Acknowledgement and Funding: None to declare