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Small, tricky, atrial septal defect in a 44-year-old male. Transthoracic and transesophageal echocardiography failed to depict the atrial septal defect in spite of clinical suspicion of a left-to-right shunt.
A. Axial spin-echo MR image shows intact interatrial septum at the level of the aortic valve.
B. Spin-echo image cephalad to A shows a small defect (arrow) in the periphery of the interatrial septum near the junction with the superior vena cava.
