A 9-year-old male with symptoms of apnea and syncope was referred for surgical resection of a herniatedleft atrial appendage. During 3 years of care, the patient experienced an increasing number of episodes characterized by loss of consciousness and "spells" during vigorous physical activity, in which he reportedly turned blue around the lips and experienced staggering. Multiple cardiovascular exams, electrocardiograms, and 24-hour Holter monitors were normal. Imaging by chest radiograph showed a prominence in the left parasternal region and pulmonary artery region. Subsequent echocardiograms also showed an increased density anterior to the pulmonary artery suggestive of a mass. Cross-sectional imaging and three-dimensional reconstruction by magnetic resonance imaging showed an enlarged left atrial appendage herniating through a partial defect of the left pericardium.
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