What's in a Mass?: Large Native Mitral Valve Mass

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Presentation transcript:

What's in a Mass?: Large Native Mitral Valve Mass Stacey J. Howell, MD, Ananya Datta Mitra, MD, Ezra A. Amsterdam, MD The American Journal of Medicine Volume 130, Issue 5, Pages e171-e175 (May 2017) DOI: 10.1016/j.amjmed.2016.12.038 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 1 (A) Transthoracic echocardiogram, parasternal long-axis view, demonstrates suggestion of a mass (arrow) adjacent to the anterior leaflet of the mitral valve. (B) Transesophageal echocardiogram, midesophageal 2-chamber view in diastole and (C) systole, clearly shows the mitral valve mass. The mass is attached to the anterior mitral leaflet, measuring 2.2 × 1.5 cm. AO = aorta; LA = left atrium; LV = left ventricle; RV = right ventricle. The American Journal of Medicine 2017 130, e171-e175DOI: (10.1016/j.amjmed.2016.12.038) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 2 Cardiac computed tomography obtained for surgical planning before cardiothoracic surgery highlights the sizable mitral valve mass as demonstrated by the large filling defect (arrow). The American Journal of Medicine 2017 130, e171-e175DOI: (10.1016/j.amjmed.2016.12.038) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 3 Intraoperative viewing of excised mitral valve mass. The mass involved 50% of the medial aspect of the anterior mitral leaflet with attachment to multiple major chordae. The American Journal of Medicine 2017 130, e171-e175DOI: (10.1016/j.amjmed.2016.12.038) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 4 Pathology including gross specimen (A) and histology (B-E). (A) Mitral valve leaflets with partially disrupted 2.2 × 1.5 × 1.5-cm polypoid nodule with a smooth tan-brown outer surface and brown-red inner soft tissue. (B) Entire cross-section of the mitral valve mass showing intramural thrombus (center) (hematoxylin–eosin, magnification 2×). (C) Low-power view of the mitral valve mass showing intramural thrombus (arrow) with dense acute inflammation (center) (hematoxylin–eosin, magnification 10×). (D) High-power field of the mitral valve mass (C) showing dense acute inflammation (hematoxylin–eosin, magnification 50×). (E) Low-power view of the mitral valve mass showing significant increase in hemosiderin-laden macrophages (hematoxylin–eosin, magnification 10×). The American Journal of Medicine 2017 130, e171-e175DOI: (10.1016/j.amjmed.2016.12.038) Copyright © 2017 Elsevier Inc. Terms and Conditions