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We present the case of a 66-year-old man admitted with progressive dyspnoea in the last 4 years. He was diagnosed with severe rheumatic mitral stenosis by transthoracic echocardiography (TTE) before hospitalisation and was scheduled for mitral valve replacement. However, preoperative TTE, transoesophageal echocardiography (TEE) and CT revealed a mass in the posterior mitral annulus (figure 1A–D, yellow arrows). He reported recent anorexia but denied thoracalgia or fever. Laboratory examination indicated mild anaemia. White blood cells, C reactive protein, rheumatoid factor and erythrocyte sedimentation rate were all in normal ranges.
Contributors All authors contributed to acquisition of clinical and imaging data, ideation and draft of the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.