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EHS

Evaluation of an incidental cardiac finding in a patient with bronchitis

Clinical introduction

A 63-year-old man with HIV presented with 1 month of dyspnoea and productive cough without orthopnoea. He was afebrile with normal blood pressure, borderline tachycardia and mild pulmonary wheezing. He had exertional hypoxia requiring 4 L per minute of oxygen. No murmurs, jugular venous distention or lower extremity oedema was noted. Clinical evaluation included transthoracic echocardiography (TTE), which showed mild left ventricular hypertrophy with normal size and systolic function. The right ventricle was normal. There was mild aortic insufficiency; other valves were normal. An abnormality was incidentally seen at the aortic root.

The patient was treated for bronchitis and chronic obstructive pulmonary disease exacerbation, while further evaluation of the incidental aortic root finding was performed with transoesophageal echocardiography (TEE) and cardiac MRI (CMR).

Question

What is the most likely diagnosis for this finding?

  • Sinus of Valsalva aneurysm.

  • Chronic aortic dissection.

  • Left ventricular outflow tract (LVOT) pseudoaneurysm.

  • Right coronary artery aneurysm.

  • Aortic root abscess.

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