An unusual shadow above the aortic valve

Area of Science:

• Cardiovascular Medicine
• Diagnostic Imaging
• Pathology

Background:

• A 55-year-old West African man with hypertension presented for routine echocardiography.
• Clinical examination revealed murmurs suggestive of aortic insufficiency.
• Initial ECG and chest X-ray showed mild left ventricular hypertrophy and a normal cardiac silhouette.

Observation:

• Transthoracic echocardiography revealed an unusual appearance above the aortic valve and a shadow in the aortic arch.
• Transesophageal echocardiography and CT were performed to further evaluate the aorta and aortic valve.
• The native aortic valve was trileaflet with moderate regurgitation.

Findings:

• Imaging demonstrated findings consistent with intimo-intimal intussusception.
• This rare condition presented as an unusual mass-like lesion above the aortic valve.
• Moderate aortic regurgitation was a significant associated finding.

Implications:

• Intimo-intimal intussusception is a rare cause of aortic insufficiency that can be diagnosed with advanced imaging.
• This case underscores the importance of considering rare diagnoses in patients with unexplained aortic valve pathology.
• Accurate diagnosis is crucial for appropriate management and patient outcomes in aortic diseases.