Clinic introduction

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.