407 AN INCIDENTAL FINDING OF A CHALLENGING MITRAL MASS

Abstract A 53-year-old woman, with no previous cardiologic history, presented to our emergency department reporting a pleomorphic symptomatology that had been affecting her in the last few months. She complained weakness, dyspnea for severe exertion and intermittent atypical chest pain worsening supine position. The patient history of migraine aura. On admission she was asymptomatic apyretic. Her blood pressure 120/80 mmHg. Clinical examination revealed rhythmic heart sounds without murmurs, normal lung sounds, jugular venous distention peripheral edema, signs nor symptoms infection. laboratory tests showed cardiac high-sensitivity troponin I (4.1 ng/L), BNP levels (4 ng/L) C-reactive protein 0.3 mg/dL. electrocardiogram sinus rhythm rate 86 beats/min, AV conduction ventricular repolarization were within limits. Transthoracic echocardiogram sized (end-diastolic diameter 40 mm), slightly hypertrophic left ventricle (interventricular septum thickness 12 mm) ejection fraction (55%), inferior-lateral wall curling grade diastolic dysfunction. Left atrium size normal. 15×14 mm globe-shaped echogenic structure seen protruding throughout whole cycle, which apparently originated from P2 scallop (Figure 1A). There mitral regurgitation or stenosis. Aortic valve Inferior vena cava not dilated collapsing. During hospitalization always apyretic asymptomatic, culture negative. Transesophageal echocardiography saccular cavitary structure, 14 bulging posterior leaflet toward systole diastole 1B). Differential diagnosis included tumor (e.g., fibroelastoma), aneurysm and/or excessive prolapse. absence endocarditis, involvement favored first hypothesis, whilst morphology latter. Libman-Sacks endocarditis excluded thanks lesions cancer autoimmune disease. We performed MRI investigation confirmed presence bi-leaflet prolapse thickened, dysmorphic abnormal any evidence tumors 2). No found. Adiposus intramyocardial tissue also reported wall, supporting aneurysmatic leaflet. Finally, brain prior cerebral embolism. therefore decided follow-up patient, who at 6 months remained medical therapy. Figure 1.A: transthoracic (apical four-chamber view) showing mass. B: transesophageal (three-chamber view X-plane section) mass as an level. C: 3D leaflet.Figure 2.Cardiac aneurysm.