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Heart, Lung and Circulation

A Not So Innocent Murmur

Published:August 01, 2022DOI:https://doi.org/10.1016/j.hlc.2022.04.055
      A 45-year-old female was found to have a heart murmur during a routine check-up. Transthoracic echocardiogram showed normal chambers volumes and biventricular systolic function; there was mild tricuspid regurgitation with a transvalvular gradient of ±56 mmHg and an elevated gradient (±32 mmHg) was present in the suprasternal view (Figure 1A ).
      Figure thumbnail gr1
      Figure 1(A) Suprasternal view of the transthoracic echocardiogram showing a high gradient from an uncertain origin. (B) Thoracic angio-CT revealed an almost occlusive mass in the main pulmonary artery’s lumen. In MRI, the mass presented a high-intensity signal on T2-weighted images (C), heterogenous first-pass perfusion (D) and late gadolinium enhancement (E). (F) shows the thoracic CT nearly one year after the initial diagnosis, with a significant increase in the size of the mass and infiltration of the heart chambers.
      Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.

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