Case 391

Case 391

Medical history

Male patient, 21-years-old, reports fatigue, dizziness and dyspnea during usual activities. No comorbidities reported. Physical examination showed lower limb edema, a visible apex beat palpable with 3 digitals, grade II Levine proto systolic murmur, an elevate jugular venous pressure, tender hepatomegaly, and lesions as observed in Image 1. Further propaedeutic revealed ejection fraction of 35% and the radiologic findings as seen in Images 2 and 3. The diagnosis was tuberous sclerosis complex (TSC).




Question:
Considering the clinical history and images presented, which typical finding of this diagnosis was NOT seen in this case?

Test question

(SBP, 2008 - adapted) A nine-months-old patient, that presents epileptic seizures since the second month, is hospitalized with signs and symptoms of heart failure. Physical examination shows hypopigmented macules, leaf-like shaped, distributed in trunk and proximal parts of superior limbs. Echocardiogram shows the presence of an intracavitary nodule attached to the anterior wall of the left atrium.

Question:
The most likely diagnosis is:

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