Background: Anomalous origin of the left coronary artery from the pulmonary Arising artery (ALCAPA, also called a Bland-White-Garland) is rare congenital heart defect causing significant diagnostic problems. The disease has a poor prognosis. Most patients die in early childhood, if the defect is not detected and operated on time. Failure may result in myocardial ischemia, impaired left ventricular function and progressive heart failure.
Clinical Presentation: 13 month girl was admitted to hospital with suspected pleuropneumonia due to attenuation of the respiratory murmur on the left side during auscultation. For several days she was treated for upper respiratory tract infections. She had no shortness of breath or fever, she was in good general condition.
The patient underwent lung ultrasound performed by a pediatrician in an emergency room. The study showed an enlarged heart with a huge left ventricle and atelectasis of the lower segments of the left lung. Chest X-ray confirmed the changes observed in the ultrasound. The patient was transferred to the Pediatric Cardiology Clinic for further diagnosing.
Subsequent studies (echocardiography, ECG, aortography) allowed the identification of ALCAPA.
Conclusion: In our patient the ultrasound was the first diagnostic test which showed that the child's symptoms are associated with a heart defect and determinated further evaluation. This allowed the rapid application of appropriate treatment.
In situation of enlargement of the left ventricle, especially in a young child or infant, the diagnosis of ALCAPA should be considered.
