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.