A dairy worker with fever and an abnormal echocardiogram.

DESCRIPTION OF THE CASE: A 38-year-old male presented with history of progressively increasing dyspnoea of 25 days duration. He gave history of low -grade fever associated with malaise and weight loss over the preceding 6 months. He worked in the dairy industry in the Middle East and returned to India owing to his illness. On clinical examination, he was found to be tachypneic and cachectic. Jugular venous pressure was raised with a prominent 'a' wave. There was a short early diastolic murmur over the aortic area. His blood investigations, including renal and liver function tests, were normal. Three sets of blood cultures were sterile. Two-dimensional trans-thoracic and trans-oesophageal echocardiography revealed thickened bicuspid aortic valve cusps, with moderate eccentric aortic regurgitation and an abnormal structure posterior to the left ventricular outflow tract and aorta (figure 1A-C). A small vegetation was seen attached to the fused right-left aortic cusp (supplementary figure 1). The patient was started on appropriate intravenous antibiotics and antifailure medications, and was referred for early surgical treatment.Figure 1(A) Transthoracic echocardiography parasternal long axis view. (B) Transesophageal echocardiography (mid esophageal level) long axis view. (C) Transthoracic echocardiography parasternal short axis view.10.1136/heartasia-2017-010915.supp1Supplementary Figure 1. QUESTION: Identify the structure depicted in the images (figure 1A-C).Answer options:Cor triatriatumAortic dissectionLeft atrial pseudoaneurysmPseudoaneurysm of the mitral aortic inter-valvular fibrosaAortic root abscess.