RSOV Mimicking Liver Disease: Dilemma of Diagnosis

A 46-year-old man was admitted to the gastroenterology department, with a running diagnosis of Chronic Liver Disease (CLD) with Liver Cirrhosis and Congestive Hepatomegaly. The patient's only symptom initially was abdominal pain with distensions. The patient first sought medical advice from a local gastroenterologist but didn't get any relief.

The patient then consulted another gastro doctor and underwent USG abdomen and CT abdomen. USG revealed mild hepatomegaly and fatty changes with right pelvic ascites. CT abdomen showed congestive hepatomegaly and mild ascites and bilateral pleural effusion. Fibroscan showed median stiffness of 50.5 kpa.

The patient progressively developed breathlessness. The patient was being treated on liver disease lines by the outside gastroenterologist with symptomatic treatment. The patient was admitted to Max Hospital, Dehradun, under a gastroenterologist, but his condition was progressively deteriorating. No apparent murmur on auscultation. The patient underwent echocardiography twice, but no findings were evident. The patient again underwent echocardiography where flow between NCC of the aortic valve and right atrium of the heart was found; thus, diagnosis of the Ruptured sinus of Valsalva aneurysm (RSOV) was confirmed.

The patient's condition was deteriorating acutely, breathlessness at rest, could not lie down, and not maintaining oxygen saturation even on NIV support. The family was counselled about the disease, and the patient was immediately taken to OT for emergency surgery.