Diagnostic dilemma| Volume 25, ISSUE 5, P889-890, October 2011

A Mitral Valve Mass: Tumor, Thrombus, or Vegetation?

Published:August 12, 2010DOI:
      A 58-YEAR-OLD man developed transient monocular visual loss in the right lower quadrant of the left eye that fully resolved in less than 24 hours. He was afebrile and had no other symptoms. His known medical history included well-controlled arterial hypertension and dyslipidemia. He denied a history of cerebrovascular disease, atrial fibrillation, intravenous drug use, and thromboembolic disease. Medical evaluation included a carotid Doppler ultrasound that showed no abnormality, an unremarkable brain magnetic resonance imaging (MRI) examination, an unremarkable ophthalmologic examination, and a normal white blood cell count. A transesophageal echocardiographic (TEE) examination was performed and showed moderate mitral regurgitation in the setting of bileaflet prolapse. Additionally, an 8 × 7 mm mass was found to be attached to the atrial side of the anterior leaflet of the mitral valve (Fig 1, Fig 2 and Videos 1 and 2 [supplementary videos are available online]). The patient was scheduled for mitral valve reconstructive surgery and mass resection 3 weeks after his medical evaluation had been completed. What is the diagnosis?
      Figure thumbnail gr1
      Fig 1Real-time 3-dimensional TEE “zoom mode.” A mass is seen on the A3 segment.
      Figure thumbnail gr2
      Fig 2A midesophageal long-axis view. An 8 × 7 mm mass is seen on the left atrial side of the A3 segment of the anterior leaflet.

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