An unusual shadow above the aortic valve. Issue 24 (11th August 2016)

• Record Type: Journal Article
• Authors: McWilliams, Eric; Zehr, Kenton; Alshehri, Ali
• Is Part Of: Heart. Volume 102:Issue 24(2016)
• Page Start: 1942
• Page End: 1942
• Publication Date: 2016-08-11
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2016-309932
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Clinical introduction: A 55-year-old West African man was referred for routine echocardiography. He was completely asymptomatic, a non-smoker, working out at the gym several times weekly. He was taking hydrochlorothiazide for hypertension. Clinical examination revealed a blood pressure of 156/74 mm Hg and systolic and diastolic murmurs suggestive of aortic insufficiency. Pulses were equal bilaterally and he had no marfanoid features or hyperelasticity. ECG showed mild left ventricular hypertrophy and chest X-ray revealed a normal cardiac shadow and mediastinum. Transthoracic echocardiography demonstrated an unusual appearance above the aortic valve (figure 1 A), moderate aortic regurgitation and a shadow in the aortic arch. Transoesophageal echocardiography was performed to evaluate the dilated aorta, arch and aortic valve further (figure 1 B, C). The native aortic valve was trileaflet with moderate regurgitation. CT was also performed (figure 1 D). Question: What is the most likely diagnosis? Acute type A aortic dissection Williams syndrome Loa loa worm infection Intimo-intimal intussusception Giant cell aortitis