Large left ventricular outflow tract mass in a young patient: uncommon presentation of a common disease! A case report

TL;DR

A young man presented with a rare heart mass caused by infective endocarditis, requiring surgery and antibiotics for successful treatment.

Contribution

Highlights an unusual case of infective endocarditis presenting as a large left ventricular outflow tract mass in a young patient.

Findings

Infective endocarditis can present as a large LVOT mass, causing severe aortic and mitral valve issues.

Timely diagnosis and treatment with antibiotics and surgery led to a successful recovery.

Multidisciplinary care and imaging were crucial for managing this atypical case.

Abstract

Infective endocarditis (IE) predominantly involves the cardiac valves. Timely diagnosis and initiation of therapy significantly reduce morbidity and mortality. Infective endocarditis presenting as a large left ventricular outflow tract (LVOT) mass is an atypical manifestation that provides significant challenges to the treating team.

A 19-year-young male presented with exertional shortness of breath, palpitations, and presyncope for 4 months with constitutional symptoms for the last 6 months. Two-dimensional echocardiogram showed a large LVOT mass arising from the mitral aortic intervalvular fibrosa causing dynamic severe aortic valve obstruction, moderate aortic regurgitation, and severe mitral regurgitation. He was managed on lines of IE and received intravenous antibiotics. In view of worsening heart failure and cardiogenic shock, he underwent mass excision, mechanical aortic valve replacement, and mitral valve repair. Histopathology confirmed it as vegetation. He was discharged and is doing well at 2-month follow-up.

An atypical presentation of IE as a large LVOT mass was observed in this young male. Sound clinical judgement, judicious use of ancillary imaging, and a multidisciplinary approach ensured timely diagnosis and appropriate treatment. Management included appropriate intravenous antibiotics followed by surgery.

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