A lady aged 30 years came with the complaints of swelling at the anterior aspect of the neck even with the chin, with breathlessness due to this swelling, which got < during night. On examination the swelling moves while swallowing. Examination of mouth showed great dryness. Echocardiogram illustrated that she is suffering from valvular insufficiency. She had palpitation before and during menses. She also had sore throat < after eating sweet things.


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