{'fraction_non_alphanumeric': 0.04580152671755725, 'fraction_numerical': 0.006679389312977099, 'mean_word_length': 5.435582822085889, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A Bulge in the Mid‐Left Cardiac Border: What Is the Diagnosis?

A 21-year-old man presented with shortness of breath, NYHA class II for the past 2 years. He denied any history of palpitation/orthopnea/paroxysmal nocturnal dyspnea/pedal edema or rheumatic fever. On auscultation, a grade III/VI apical pansystolic murmur and a left parasternal short early diastolic murmur were audible. A 12-lead ECG revealed sinus rhythm, left atrial (LA) enlargement, and left ventricular (LV) volume overload, while chest x-ray PA view demonstrated mild cardiomegaly, an enlarged left atrium (LA), and a prominent outpouching along the left mid-cardiac border (Fig. 1A,B). The usual differential diagnosis of such a bulge includes enlarged LA appendage, ruptured sinus of Valsalva aneurysm, dilated right ventricular subinfundibulum, absent pericardium, pericardial cysts, etc. Transthoracic and transesophageal echocardiography (Fig. 2A–D) showed a normal-sized LV with normal systolic function, mild mitral regurgitation (MR), and moderate aortic regurgitation