P458 AN UNUSUAL REINDEER–IS LEFT VENTRICULAR MASS

Abstract A 90–year–old woman is brought to the closest emergency room after being found in a confusional state of mind, with lateral–sided sight deviation normal cardiovascular findings. Her past medical history characterized by presence systemic hypertension, moderate–to–severe chronic disease. The 12–lead electrocardiogram showed sinus rhythm and aspecific anomalies left ventricular repolarization. Lab tests white blood cells count increased creatinine levels quite flogosis indices. An initial transthoracic echocardiogram (TTE) mild concentric hypertrophy preserved systolic function, but also revealed moving posterior mitral leaflet mass, determining regurgitation. head CT scan was performed, showing right temporo–insular ischemic ipodensity. Considering echocardiographic neuronal findings, transesophageal (TEE) indicated look for better describe suspicious beginning an antibiotic therapy empiric regimen. TEE revelead multi–lobular mass inhomogeneous echogenicity, leaning on annulus atrial side that fissurated, leading appendage emptying velocity absence thrombi. It not easy this morphology dimensions, some projections, it reminded us reindeer various antlers. This case could resemble classic valve endocarditis, evolved into fissuration arterial embolization stroke, unusual fact laboratory no alteration during whole hospitalization, really minimal CRP change always negative procalcitonin. That why we came idea such represent classical endocarditis. characteristics thrombus were encountered, may be tumor. most frequent tumors involving heart valves are papillary fibroelastomas. clinic hints led consider differential diagnosis: fibroelastomas mostly occur older ages, they frequently have or aortic location can embolize, differently from vegetations, located basal leaflet.