title: Silent rupture of sinus of Valsalva aneurysm: a refutation of the Okham's razor principle.
abstract: Aneurysm of the sinus of Valsalva is an uncommon congenital lesion rarely reported in children. Unruptured aneurysms commonly go undiagnosed until a rupture has occurred. Usually, ruptured sinus of Valsalva presents with cardiac failure. There may be a history of trauma or infective endocarditis preceding the rupture. Asymptomatic paediatric presentation of ruptured sinus of Valsalva is rare. We discuss the cases of two children who presented with a murmur and were diagnosed with ruptured sinus of Valsalva. This unusual presentation in children highlights the importance of careful routine physical examinations and the evaluation of new murmurs. The Okham's razor principle states that "when you hear hoofbeats - think horses not zebras". Sometimes, it is important to think beyond the usual in medicine, to avoid missing lesions that, if left untreated, could lead to adverse outcomes.
authors: Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, USA.
authors: Joseph
authors: J
authors: Dayan
authors: Suvro
authors: S
authors: Sett
authors: Usha
authors: U
authors: Krishnan
mesh_terms: D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D003937:Diagnosis, Differential; D004452:Echocardiography; D006801:Humans; D008297:Male; D012850:Sinus of Valsalva