Atrial septal aneurysm (ASA) is a well known morphologic abnormality and has been largely investigated with both transthoracic (TTE) and/or transesophageal echocardiography (TEE) (1-3). Its association with other congenital and acquired heart diseases and midsystolic clicks has been reported (3-5). ASA also may be associated with an increased risk of embolic events (1,2). In many cases, it is an incidental finding. We describe a patient with acute renal failure associated with nephrotoxic drugs and ASA suggesting endocarditis.