Case 3-1974

Presentation of CaseA 57-year-old man was admitted to the hospital because of painful swelling of the leg.The patient was known to have a heart murmur since birth, and his activity had always been limited by exertional dyspnea. Forty-one years before admission, at the age of 16 years, he came to this hospital for evaluation. Physical examination revealed a pectus excavatum deformity, with a harsh systolic murmur to the left of the sternum and a + + second heart sound to the left of the sternum. There was slight cyanosis of the digits, without clubbing. The hemoglobin was "90 . . .