Dr. Pepe’s Diploma Casebook: Case 13 – SOLVED!

Dear friends,

This week’s case is a sixty-year-old male with progressive exertional dyspnea.

Most likely diagnoses:

1. Arrhythmogenic right ventricular dysplasia
2. Tricuspid valve endocarditis
3. Ebstein anomaly
4. Giant aneurysm of the right atrium

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    11 Responses to : Dr. Pepe’s Diploma Casebook: Case 13 – SOLVED!

    1. Manolis says:

      Giant aneurysm of the right atrium.

    2. Genchi Bari Italia says:

      Dal radiogramma in AP avrei detto versamento pericardico:la RM , secondo il piano delle 4 cavità cardiache, chiarisce la estroflessione aneurismatica originante dall’atriop dx, con comprressione e disolocazione delle restanti cavità cardiache.

    3. Kelvin says:

      Wrong age group for Ebstein’s – such patients should present in the peri-natal period.

      I cannot see any signs of endocarditis around the visible bit of the tricuspid valve.

      We can barely make out the right ventricle (it being so small as compared to the right atrium)…let alone comment on it being dysplastic.

      The right atrium is huge! It is compressing the left heart…with deviation of the atrial septum towards the left (indicating very high right atrial pressures). So I would consider the possibility of a congenital aneurismal right atrium!

      Besides that, on the CXR, there is upper lobe venous diversion together with an interstitial infiltrate…quite suggestive of decompensated CHF.

    4. Sumat says:

      Epstein anomaly

    5. Sumat says:

      Ebstein anomaly

    6. Carlo says:

      Tricuspid valve insuffiency acquired [in 60 old male ](endocarditis?)with valvular plane dilated
      there is also an increased marking vessels in lungs’s fields with congestive vascularity pattern.

    7. Alisha says:

      Giant aneurysm of rt atrium .ebstein anomaly not possible in this age.

    8. Dr. Pepe says:

      Dra. Soler (who prepared the case) answers: Ebstein may occur in adults. See the paper by Yalonetsky in the Am J Cardiol 107:767-773, 2011. In 31 patients range of age 21 to 68 years.

    9. Ieva says:

      i would say Ebstein, had seen a case that was told to present at the age of 46.