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A 1-year-old Japanese girl was referred to our hospital with a heart murmur. The patient had no other symptoms indicating cardiovascular or respiratory problems. A chest radiograph revealed a bulging upper-left heart border without cardiomegaly (figure 1A). Further examinations were performed to determine the cause of the heart bulge. Potential causes included enlargement of the pulmonary artery, a mediastinal tumour, a cardiac tumour, a pericardial cyst and left atrial enlargement due to mitral valve disease or atrial aneurysm.
ECG examination showed normal sinus rhythm, but an echocardiogram revealed a left atrial appendage aneurysm (LAAA) without thrombosis (figure 1B and C). Chest CT showed a LAAA (figure 2A, indicated by a white arrow), interposition of the left lung (a white arrowhead) between the LAAA and the left ventricle and …