# An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment

## TL;DR

A 72-year-old woman with a cardiac mass was diagnosed and treated using multiple imaging techniques, revealing the mass was a thrombus, not a tumor.

## Contribution

This case highlights the diagnostic challenges and the importance of multimodal imaging in distinguishing thrombi from tumors in mitral valve disease.

## Key findings

- Multimodal imaging confirmed the cardiac mass was a thrombus, not a tumor.
- The patient's postoperative follow-up showed normal valve function and no remaining intracardiac masses.
- Neovascularization was observed, though its specificity to severe mitral valve disease remains unclear.

## Abstract

Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass’ blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.