A 64-years old man who had been experiencing worsening dyspnea and atypical chest pain in the past 6 months, was admitted to our department. Upon arrival, physical examination revealed a 2-3/6 systolic murmur heard best over the left second intercostal space. Transthoracic echocar diography was promptly performed showing a thin-walled outpouching at level of right sinus of Valsalva, sized 45 x 50 mm (Fig. 1A). In parasternal short axis view, this appeared completely obliterate right ventricular out flow tract (RVOT) and color Doppler showed turbolent flow in this site; pulmonary valve was not well visualized (Fig. 1B, Video 1). Continuous wave Doppler study confirmed the obstruction with a peak velocity of 3 m/sec and peak gradient of 36 mm Hg (Fig. 1C). A contrastographic study with Sonovue® allowed to exclude a communication between the outpouching and the right ventricle (Video 2, 3). According to the anatomical site and echocardiographic findings the diagnosis of unruptured right sinus of valsalva aneurysm was made. To better define its relationship with nearest cardiac structures and to plane a correct surgical strategy, computed tomography (CT) was performed, confirming the presence of the aneurysm and the RVOT obstruction below pulmonary valve (Fig. 1D-F). The patient underwent surgical intervention; the aneurysm was removed with subsequent complete relief of the symptoms during the postoperative period.