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The diagnosis of patent ductus arteriosus Botalli is usually established by the simultaneous finding of a continuous murmur over the pulmonary area, frequently accompanied by a thrill, and prominence of the pulmonary artery together with "hilar dance" at fluoroscopy. Right heart catheterization has made possible a closer study of the haemodynamic and circulatory effects of the arteriovenous shunt in cases of patent ductus and other congenital heart lesions, and will thus increase the precision of the diagnosis. A diagnostic mistake therefore seems unlikely, provided these investigations are undertaken. In this paper, however, we report a case in which there was a continuous murmur over the pulmonary area, confirmed by phonocardiogram, and where the fluoroscopy and radiograph were judged to be fairly characteristic of a patent ductus arteriosus by the radiologist who studies.most of the patients with congenital heart disease brought to the clinics of Nylin and Crafoord. Right heart catheterization was not performed, but it is clear from the operative findings that it would have given no aid in establishing the diagnosis before operation. Instead of a patent ductus, the operation revealed an abnormal artery, originating from the base of the heart and winding along the wall of the pulmonary artery, with which it communicated through an aneurysmal dilatation. This imitated the symptoms and signs,of a patent ductus in the production and propagation of murmurs, and also, to a certain extent, radiographically. As there was an arteriovenous shunt from the arterial to the venous side of the heart, it would probably not have been possible by blood gas analysis of samples taken by right heart catheterization to deduce in detail the nature of the shunt. However, the diagnostic-error was only an anatomical one; operation would equally have been indicated, even had the true nature of -the abnormality been suspected.Although there have been some recent -articles about pulmonary aneurysm, and also about abnormalities of the coronary arteries, we have not been able to find any report of a congenital communication between the coronary and the pulmonary arteries. It is evident from the studies of d'Aunoy and von Hamm (1934), Boyd and McGavack (1939), Nixon (1944), and Holmes (I944) that there are real aneurysms of the pulmonary artery and that these are sometimes com-

cytes 1 per cent; 33 per cent of the cells were unrecognizable and were classified as "smudges." The number of platelets was greatly diminished. Before roentgen therapy was instituted, the total white cell count rose to 102,400 per cubic millimeter.Irradiation was instituted with small doses of 25 to 50 roentgens to areas 15 by 15 cm. over the chest, then changed to 50 roentgens by the quadrant technic (chart 6). With a total of 425 roentgens for the series the count gradually fell to 16,000 per cubic millimeter during a period of eighteen days. The proportion of segmented cells rose to 13 per cent, and the number of "smudges" dropped from 33 per cent to 12 per cent.

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