J Cardiovasc Ultrasound.  2015 Dec;23(4):271-273. 10.4250/jcu.2015.23.4.271.

Unexpected Pathologic Diagnosis of the Mitral Valvular Mass

• Kim SA
• Park SM
• Hwang SH
• Kim MN
• Son HS
• Shim WJ

• KMID: 2144460
• DOI: http://doi.org/10.4250/jcu.2015.23.4.271

Abstract

A 59-year-old man with multifocal cerebral infarction was found to have the large obstructive mitral valvular mass. Although benign tumor was under suspicion before surgery, he was finally diagnosed as chronic infective endocarditis by microscopic evaluation. The precise diagnosis and the proper management of a cardiac mass are very important since even the benign tumor may cause fatal complications. However, primary cardiac mass has the broad spectrum from pseudo-tumor to malignancy and the differential diagnosis using non-invasive methods is not easy even with the currently available imaging techniques.

Keyword

Cardiac mass; Infective endocarditis; Cerebral infarction

MeSH Terms

Cerebral Infarction
Diagnosis*
Diagnosis, Differential
Endocarditis
Humans
Middle Aged

Figure

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  Fig. 1 Transthoracic (A) and transesophageal (B) echocardiographic images of the mitral valvular mass. The mass was located on lateral mitral commissure, which made severe mitral stenosis. The surface of mass had several irregular with oscillating strands and tags.

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  Fig. 2 Early perfusion image (A) and late gadolinium enhance image (B) of the mitral valve (arrow). At early perfusion image, the mass showed low signal intensity whereas high signal intensity was detected on late gadolinium enhance image.

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  Fig. 3 Gross image of the mitral valve apparatus shows well demarcated mass with greyish surface and filthy, amorphous oscillating structures on it in atrial side (A), but grossly normal valvular surface in ventricular side (B).

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  Fig. 4 Microscopic finding (hematoxylin and eosin, × 100) of the mitral valvular mass were composed of extensively thickened valvular leaflets with organizing thrombus. On valvular structure, plenty of lymphocytes and plasma cells on atrial surface and myxoid degeneration in ventricular side were presented.

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