Christian Valentin Eisenring

This is a case presentation of an 18-month-old female who presented to the emergency department with altered mental status. In the emergency room, the patient’s electrocardiogram (EKG) raised concerns for biventricular hypertrophy. A transthoracic echocardiogram indicated that her right coronary artery originated from the main pulmonary artery (ARCAPA) and measured approximately 1.8 to 2.2 mm, widening distally to 2.2 to 2.4 mm (z-score approximately 2).

Patient Details A fifteen-year-old boy with a past medical history of asthma presented with sudden onset chest pain and orthopnea. Imaging workup in the emergency department included a chest X-ray that suggested a mediastinal mass. (A cardiac CT was initially deferred given the patient’s clinical stability.) Advanced cardiac imaging with MRI was chosen for superior soft tissue characterization and avoidance of ionizing radiation.