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.