Case Presentation :
We report an unusual case of LA impression , where the compression was
caused by unusual structure , not reported in the literature .
43 years old female presented to us with marked breathlessness ( even on
slight exertion of going to toilet ) for past 10 years with recent
worsening of symptoms to NHYA III -IV. She also complaints of occasional
hemoptysis and frequent history of recurrent paroxysmal nocturnal
dyspnoea. She relates to her illness with history of fall on staircase
approximately 10 years prior to presentation. Patient gives history of
backache also since 10 years. No history of fever is present. Physical
examination revealed pulse of 110/mt , BP of 100/70 mm Hg ( right arm
supine position ), respiratory rate of 24 /minute. On auscultation ,
first heart sound was heard with mid diastolic rumble over precordium.
The second heart sound was normally heard with loud pulmonary component.
Xray chest was normal. ECG showed partial RBBB with right axis
deviations(Fig.1).
Echo showed evidence of LA compression/ impression by a posterior
structure with normal RV and LV function. Evidence of raised LA pressure
was seen due to compression/ impression (Fig 2,3,4 and Video 1,2,3).
Patient was subjected to CECT-Chest, which showed evidence of dorsal
spine producing compression/ impression of LA (Fig.5,6,7). Patient was
advised decompression surgery of spine along with medical management.
Patient did not agree for surgery and finally succumbed to her illness.