Mitral Valve Prolapse Imitating a Mass Lesion

Two case reports are presented of patients who were initially evaluated at other centers and referred to us for further management of suspected infective endocarditis (IE). The first case involved a 60-year-old male who had a 3-day history of low-grade fever, but without any symptoms of palpitations, dyspnea, orthopnea, or paroxysmal nocturnal dyspnea. He was referred with a probable diagnosis of IE. The second case involved a 35-year-old female who had a few days of low-grade fever and was referred for echocardiography after being diagnosed with IE elsewhere, despite failing to meet the modified Duke criteria. The remaining baseline investigations, including the hemogram, renal function test, liver function test, and markers of infection and inflammation, were all normal. In both cases, transthoracic echocardiography revealed a mass-like lesion on the anterior mitral leaflet, prompting the use of transesophageal echocardiography (TEE). The TEE identified mitral valve prolapse (MVP) with multiple scallop prolapse in various views, along with thickened, elongated, and redundant leaflets. This emphasizes the importance of considering MVP as a potential cause of a mass-like lesion, especially when the cardiovascular examination appears normal and the patient does not meet the criteria for IE.