Fig. 1

(a)Echocardiography showing hypoecho attachment to the aortic valve (vegetation). (b) Continuous wave doppler showing a continuous flow between right coronary sinus and right ventricle, compatible with left-to-right shunt. (c) Rupture of a right coronary sinus aneurysm and interventricular septal defect. (d) Color doppler showing an image of the left to right shunt. (e) Head and neck CTA showing an M2 segment aneurysm in the left middle cerebral artery with a size of 3.1 mm×2.2 mm. (f) DSA image showing a distal aneurysm in the M2 segment of the left middle cerebral artery with a diameter of approximately 6.0 mm×6.5 mm. (g) First rupture of the IIA forming as showing by a CT image of subarachnoid hemorrhage.(h) Another rupture of the IIA was observed via a CT image of the ICH