Case description A 57-year-old Caucasian male patient with a past medical history of hypertension and pulmonary emphysema presented to the Cardiology outpatient clinic with exertional dyspnea, peripheral edema, orthopnea, and new-onset atrial fibrillation, with a III/VI continuous murmur, raising the possibility of an intrathoracic arteriovenous communication. A transthoracic echocardiogram revealed a dilated left ventricle with mildly reduced global systolic function (ejection fraction of 44%), biatrial enlargement, and mild pericardial effusion. Notably, this study showed multiple ‘rosary-like’ folds (, , -) […]