Cardiac Valve Mass revealed by Venous and Arterial Embolism: Case Report and Review of the Literature

Background Intracardiac masses are rare, occurring in approximately 0.1–0.3% of patients undergoing echocardiography. They include thrombi, vegetations, and tumors. Echocardiographic identification is often challenging and can be misleading. Case summary We report a 72-year-old man admitted for concomitant deep v ein thrombosis and a transient ischemic stroke. Transthoracic echocardiography showed a small mass appended to the mitral valve. Transesophageal echocardiography, performed to investigate paradoxical embolism showed a hyperechoic, mobile mitral mass attached to the leaflets closure line, without mitral regurgitation or stenosis. Valvular fibroelastoma, myxoma, and endocarditis were considered in the differential diagnosis; however, inflammatory markers and microbiological tests were unremarkable. Whole-body CT revealed pancreatic cancer, supporting the diagnosis of marantic endocarditis. The patient received curative anticoagulation with apixaban and was referred to an oncologist. The evolution was favorable after 3 months. Discussion We will discuss through our case and a literature review of the distinctive clinical and echocardiographic features of valve mass diagnosis.