Woman with Dyspnea

Abstract

A 51-year-old woman presented to our department with acute exacerbation of exertional chest distress and orthopnea over one day. On admission, the patient’s hemodynamics were unstable, and a continuous murmur could be heard at the upper right parasternal area. Transesophageal echocardiography identified the right atrium was commutating with an echolucent mass (Figure 1). Coronary computed tomography angiography confirmed the distal part of the expanded left main coronary artery circumvoluted from the back side of the ascending aorta to form the giant aneurysm (Figure 2) (Video E1, available at http://www.annemergmed.com.), which connected with the right atrium through a fistula (Figure 3) (Video E2).