Systolic thrill in left 2nd and 3rd intercostals space may be seen in all of the following, except
Correct Answer: Ebstein's anomaly
Description: In general, murmurs with an intensity of grade 4 or higher are accompanied by a palpable thrill. A systolic thrill is felt in pulmonic stenosis.A subpulmonic (supracristal) VSD, the thrill is felt maximum in the 2nd left intercostals space.An acyanotic patient with tetralogy of Fallot (pink tet) may have a long, loud, systolic murmur with a thrill along the right ventricular outflow tract. (A pink TOF comprises VSD and milder pulmonic stenosis along with other components.)Thrill has also been repoed in Ebstein's anomaly."Of 14 neonates, 12 presented on the first day of life and all had both cyanosis and a murmur. Eleven had loud pansystolic murmurs at the left sternal edge indicative of tricuspid incompetence, and eight of these had an associated thrill, which is a rare finding in a neonate."So, the lesser likely condition to cause a thrill, among the given options, is Ebstein's anomaly. Ref: Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition- by Main A. Alpe.
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