Discussion:
The differential diagnosis of mitral valvular masses includes, infective endocarditis, non-bacterial thrombotic endocarditis, organized thrombus, tumoral mass such as papillary fibroelastoma, myxoma, calcified tooth paste tumor of mitral annulus and blood cyst.6 Some lesions have distinctive features and can be diagnosed easily. Both Myxoma and papillary fibroelastoma have such echocardiographic findings including narrow stalk with mixed echogenic pattern in myxoma or round head with fine shimmering papilla in papillary fibroelastoma. On the other hand some mass have no specific feature at echocardiography and definite diagnosis is impossible especially when echocardiography acoustic window is suboptimal. This uncertainty results in wide differential diagnosis and mandates extensive evaluation with laboratory and other imaging tests. This patient had a bicuspid aortic valve with suspicious mobile mass which misinterpreted as endocarditis and was evaluated for both infective and non-bacterial thrombotic endocarditis. Many congenital heart diseases have multiple different presentations and sometimes have complex lesions. It is important to consider these concomitant lesions at any patient with congenital heart disease to prevent unnecessary measures and costs. According to literature, most case reports described LVOT obstruction and significant stenosis due to the accessory mitral valve, which led to surgical resection.2-5 Despite these findings, our patient didn’t have significant stenosis at LVOT and was asymptomatic.