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.