Cardiac Mass, Bacteremia, and Embolic Stroke

Background

Cardiac masses may mimic tumors or vegetations. Differentiation is essential, particularly in the context of bacteremia and embolic complications.

Case Summary

A 75-year-old man presented with fatigue, myalgia, and new-onset atrial fibrillation. Transesophageal echocardiography revealed a mitral valve mass with features suggestive of fibroelastoma or myxoma. Blood cultures were positive for Streptococcus mitis. The patient subsequently developed an intracerebral hemorrhage requiring craniotomy. Serial imaging demonstrated resolution of the mitral valve mass, supporting a diagnosis of vegetation.

Discussion

Diagnosis of infective endocarditis requires integration of clinical context, microbiologic data, and serial imaging rather than reliance on echocardiographic appearance alone. Anticoagulation strategies must be individualized after hemorrhagic events.

Take-Home Messages

Cardiac masses in the setting of bacteremia require careful interpretation as lesions that appear benign may represent vegetations. ⁠Accurate diagnosis depends on integration of Duke criteria and serial transesophageal echocardiography evaluations, rather than reliance on a single echocardiogram.