Left atrial-to-right atrial shunt without atrial septal defect or precordial murmur. Pulmonary varix and hypertrophic cardiomyopathy

Pulmonary varix is infrequent, and when present, is usually clinically silent and found only as an incidental finding on chest roentgenogram. Hypertrophic cardiomyopathy, in contrast, is frequent, and when present, is frequently frequent clinically apparent. When the two occur together in the same patient, however, the pulmonary varix (with anomalous systemic venous connection) may become clinically apparent, the second (hypertrophy cardiomyopathy), the real culprit, may remain clinically silent and the combination may present challenging diagnostic and therapeutic difficulties which are described in this case report.