A 7-year-old child presents with a grade 3/6 harsh ejection systolic murmur at the left upper sternal border radiating to the neck, a palpable thrill, and an ejection click. ECG shows right axis deviation and tall R waves in V1. There is no cyanosis. What is the most likely diagnosis?

• A Valvular pulmonary stenosis ✓
• B Secundum atrial septal defect
• C Peripheral pulmonary artery stenosis
• D Ventricular septal defect

Explanation

Valvular pulmonary stenosis produces a harsh ejection systolic murmur at the left upper sternal border radiating to the neck, often with an ejection click and thrill. ECG demonstrates right ventricular hypertrophy with right axis deviation and tall R in V1. ASD produces fixed splitting of S2 and a flow murmur without a click. Peripheral pulmonary stenosis murmurs radiate to the axillae and back. VSD produces a pansystolic murmur at the lower left sternal border.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.