BMJ Case Reports 2012; doi:10.1136/bcr.12.2011.5402
  • Reminder of important clinical lesson

Aneurysmal ‘pepper-pot’ atrial septal defect in an older gentleman with multiple cerebrovascular attacks

  1. Aham Amadi2
  1. 1Cardiology Department, Royal Oldham Hospital, Manchester, UK
  2. 2Cardiology Department, Aintree Cardiac Centre, Liverpool, UK
  3. 3Cardiology Department, Alder Hey Children’s Hospital, Liverpool, UK
  1. Correspondence to Dr Ewan J Mckay, ewan_mckay{at}


Our patient presented to a large university teaching hospital with a history of light-headedness, falls and multiple cerebrovascular ischaemic events. This caused a right sided hemiplegia and the patient experienced significant functional limitation. Extensive investigations were carried out to exclude any causative factors such as carotid artery disease and the patient had all identifiable cardiovascular risk factors identified and modified. No significant pathology was found and a referral was made to the cardiology service. Transthoracic echocardiography revealed a complex type 3 perforate ‘pepper pot’ atrial septal aneurysm with associated thrombus. The patient was commenced on warfarin and appropriate rate limiting medication. After discussion of all interventional modalities, the patient opted for conservative management.


  • Competing interests None.

  • Patient consent Obtained.

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