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Lipomatous hypertrophy of the interatrial septum can have an atypical appearance by transthoracic echocardiography. The authors emphasize on the importance of the multimodality imaging approach to reach the appropriate diagnosis in such cases.Symmetrical peripheral gangrene is a rare condition associated with significant morbidity and mortality. The use of topical nitroglycerin may have a role in improving patient outcomes and opens a new area for future research regarding the use of topical nitroglycerin in SPG.In this study, a case o