Ebstein’s Anomaly: An Unanticipated Differential Diagnosis of Egg-on-Stick Appearance and the Diagnostic Dilemma

Patient: Female, 42-year-old Final Diagnosis: Ebstein’s anomaly Symptoms: Dyspnoea on exertion • early satiety • fatigue • orthopnea • PND • progressive abdominal swelling • weigh loss Medication: — Clinical Procedure: Paracentesis Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Ebstein’s anomaly (EA) is a rare congenital cardiac abnormality with diverse anatomic and spectra of clinical presentations. This heart anomaly occurs in approximately 1 per 200 000 live births and accounts for <1% of congenital cardiac diseases. The main pathologic finding is “atrialization” of the basal region of the right ventricle. EA has been described extensively in the literature; however, to the best of our knowledge, this is the first reported case of EA presenting with ”egg-on-stick” appearance. Case Report: A 42-year-old woman presented on account of 2 years of progressive abdominal swelling, early satiety, and progressive weight loss. There was an associated history of dyspnea on exertion, easy fatigability, paroxysmal nocturnal dyspnea, and orthopnea. General examination revealed egg-on-stick appearance: visible distended abdominal wall veins and massive ascites with no pedal edema. Overall, pertinent cardiovascular examination findings and echocardiographic features are in keeping with EA. Conclusions: We present the likely first case of egg-on-stick appearance as part of the presentation of EA, which posed a diagnostic dilemma. Echocardiography can help in unraveling this dilemma.