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A 78-year-old male with a history of hypertension and hypercholesterolaemia was admitted
to hospital with acute left eye visual loss and diagnosed with retinal artery occlusion.
Magnetic resonance imaging (MRI) revealed multiple, bilateral cerebral infarcts involving
supra- and infra-tentorial brain consistent with acute ischaemic stroke from a central
embolic source. Extended ambulatory electrocardiographic monitoring displayed sinus
rhythm with no evidence of atrial flutter or fibrillation. Transthoracic echocardiography
(TTE) revealed a cystic structure associated with the mitral valve, with no restriction
or regurgitation. Left ventricular function was preserved with no evidence of apical
thrombus. Characterisation with transesophageal echocardiography (TOE) demonstrated
the cystic mass encapsulated within the anterior leaflet of the mitral valve at the
posteromedial commissure which was well circumscribed with no independent motion or
surface irregularities (Figure 1). Infective endocarditis or abscess were thought unlikely given there were no systemic
infective symptoms and normal inflammatory markers. TOE, in conjunction with arterial
phase computerised tomography (CT) imaging, additionally revealed mild–moderate aortic
arch atheroma but no other abnormalities of possible embolic source.
Figure 1(A and B) Echocardiography in apical four chamber view showing the blood cyst attached
to the mitral valve.
