Incidental Detection of a Pulmonary Valve Thrombus in a 60-Year-Old Woman: A Case Report

Pulmonary valve thrombus is a rare cardiac finding, particularly when identified incidentally in a patient without established venous thromboembolism or infective endocarditis. We report the case of a 60-year-old woman who presented with atypical chest discomfort and exertional dyspnoea. She described a sensation of being unable to take an adequate breath, while her husband had noticed increased breathing effort during routine walking. She had no previous history of ischemic heart disease or cerebrovascular disease and was a lifelong non-smoker. Cardiovascular examination was unremarkable, with normal blood pressure and oxygen saturation. Transthoracic echocardiography initially demonstrated no significant structural cardiac abnormalities or valvular pathology. CT coronary angiography, performed to investigate her symptoms, demonstrated no flow-limiting coronary artery disease but incidentally identified a filling defect associated with the pulmonary valve. Dedicated CT pulmonary angiography excluded pulmonary embolism but confirmed the pulmonary valve lesion. Cardiac MRI demonstrated a mass associated with the pulmonary valve, with appearances most consistent with thrombus. There was no clinical, laboratory, or imaging evidence of infective endocarditis. The patient was treated with warfarin anticoagulation. Follow-up CT pulmonary angiography after three months demonstrated complete resolution of the pulmonary valve lesion, supporting the diagnosis of thrombus. This case highlights the importance of considering pulmonary valve thrombus in the differential diagnosis of an incidentally detected valvular mass and demonstrates the value of multimodality cardiac imaging in differentiating thrombus from infective vegetation and benign valvular tumours.