Case Report
A 60-year-old male patient was referred to our
emergency department with the
complaint of chest pain accompanied by palpitation for one week, and
without fever. He has hypertension, without diabetic, acute myocardial
infraction, surgery, and trauma history. His temperature was 36.5, heart
rate was 63 bpm, and his blood pressure was 95/61mmHg. he had an oxygen
saturation of 95%. Physical examination revealed a regular sinus rhythm
and a Grade III systolic murmur at the aortic area.
Blood cultures showed negative infected. The value of Brain natriuretic
peptide was 965 pg per milliliter, which was significantly increased
compared with the normal value. Clinically he had bad left ventricular
function and there were no signs of infective endocarditis.
He underwent a bedside transthoracic echocardiography (TTE) in our
center. The parasternal long/short axis view, apical four/five chamber
view, and apical long axis view were utilized. TTE (Figure 1, Movie
S1-S5) demonstrated a large and irregular cystic cavity, located in the
interventricular septal (IVS) extending from the basal
anteroseptum to anterior wall of the left
ventricle, and a cystic cavity sized about 82x63mm, within it, a
string-like echo is visible. TTE also showed enlargement of the left
atrium and left ventricle diameter and mildly reduced left ventricular
ejection fraction with 48% by simpson method. The aortic diameter was
45mm at the sinus of Valsalva and 50mm for the ascending of the aorta.
Simultaneously, the communication was observed
between aortic root aneurysm and the dissection in the IVS, and the
diameter of the orifice was roughly 10mm. A dual-phase bidirectional
blood flow spectrum was detected at the orifice of the cystic cavity.
However, we did not detect any shunt flow between the aneurysm and four
chambers. Meanwhile, the magnitude of cystic cavity did not change
significantly during diastole and systole, because cavity had a wide
range of anteroseptum and anterior wall of the left
ventricle.