Analyze This Image: All You Need Is an M-mode and a Doppler

Ronald H. Wharton, MD

Disclosures

November 11, 2019

Explanation

A history of rheumatic fever is not consistent with the echocardiographic findings in this case.

Figure 1

The CW Doppler (Figure 2) through the mitral valve shows a very high diastolic gradient (mean pressure of 18.3 mm Hg at a heart rate of 89 bpm). These findings are consistent with the typical signs and symptoms of mitral stenosis, such as dyspnea, orthopnea, and pulmonary hypertension.

Figure 2

The M-mode image (Figure 1), however, does not demonstrate the characteristic findings of rheumatic mitral disease but instead reveals a mitral valve myxoma. Myxomas, which are the most common type of primary noncancerous cardiac tumor, are usually found in the left atrium and can produce signs and symptoms that mimic mitral stenosis. Another common manifestation of myxomas is systemic embolization.

Figure 3

In Figure 3, one can see how color flow goes around the myxoma as blood travels from the left atrium to the left ventricle.

Figure 4

Figure 4 demonstrates the large left atrial myxoma in the apical 4-chamber view without the color Doppler.

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