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Mobile Mitral Valve Vegetations: Not Your Usual Endocarditis
Robert S Fain1, Sohum Patwa2, Hussain R Khawaja3
1Medical Student, Warren Alpert Medical School of Brown University, Providence, RI.
Rhode Island Medical Journal (2013)
|April 27, 2022
Summary
Mitral annular calcification (MAC) can mimic endocarditis in young patients. Trans-esophageal echocardiography (TEE) helps differentiate these mobile calcified lesions from infection.
Area of Science:
- Cardiology
- Medical Imaging
- Nephrology
Background:
- Mitral annular calcification (MAC) is a degenerative condition linked to aging and comorbidities like chronic kidney disease, diabetes, and hypertension.
- Mobile calcified lesions in MAC can be misdiagnosed as endocarditis on transthoracic echocardiograms (TTE).
- This diagnostic challenge is particularly notable in younger patients with no apparent cause for symptoms.
Purpose of the Study:
- To describe a case of mitral annular calcification (MAC) in a young dialysis patient.
- To highlight the diagnostic difficulties in differentiating MAC from endocarditis using TTE.
- To emphasize the role of trans-esophageal echocardiography (TEE) in accurate diagnosis.
Main Methods:
- Case report of a young dialysis patient presenting with dyspnea on exertion.
- Initial evaluation included transthoracic echocardiogram (TTE).
- Diagnosis was confirmed and differentiated using trans-esophageal echocardiography (TEE).
Main Results:
- Initial TTE revealed mobile lesions on the mitral and aortic valves, suspicious for endocarditis.
- Subsequent diagnosis confirmed the lesions as mitral annular calcification (MAC).
- TEE provided clear differentiation of the mobile masses.
Conclusions:
- Mitral annular calcification (MAC) can present atypically in young patients, posing a diagnostic challenge.
- Trans-thoracic echocardiography (TTE) may lead to misdiagnosis of endocarditis.
- Trans-esophageal echocardiography (TEE) is crucial for distinguishing MAC from infective endocarditis.
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