Symptoms in the presence of a giant windsock eustachian valve remnant

We present the case of a 43 year-old female with an isolated episode of atypical chest pain and an ill-defined cardiac murmur who was coincidentally found to possess a large serpiginious residual embryonic structure in right atrium. Multiple modality imaging was required to confirm this to be a rare giant eustachian valve remnant. The eustachian valve in the fetus directs oxygenated blood towards the foramen ovale. While absent or very small in adult life it rarely persists to any significant degree and must be distinguished from other right atrial shelf anomalies. The true potential of these structures to cause pathological interference with cardiac function or symptoms is unknown due to their rarity.