Microbubbles contrast inside the cyst: a pathognomonic sign of mitral valve blood cyst

Abstract

We report a case of giant blood cyst originating from the anterior mitral valve leaflet in an 18-year-old white girl. Contrast real-time transthoracic echocardiogram showed the presence of microbubbles inside the cystic cavity during diastole, confirming the presence of blood passage between the ventricular cavity and the cyst lumen and suggesting that this is a pathognomonic sign of the presence of a blood cyst. Although, in previous cases, contrast microbubbles inside the cyst have been described during systole, we report the presence of microbubbles during diastole.

Blood cyst of the mitral valve – is it common? Case report

“…[19][20][21] Some authors suggest using contrast echocardiography for a certain diagnosis, as well as for differentiating other etiologies. When injected, the contrast substance gets into the blood cyst either during systole 22 or dyastole 23 , showing the communication with the ventricular cavity.…”

Blood Cyst of the Mitral Valve Diagnosed in an Adult after Systemic Thrombolysis

“…However, cysts could be misdiagnosed as adherent thrombus [ 7 ] or bacterial vegetation such as in this case. Contrast echocardiography might be of help as stated before [ 4 ]. Related to other imaging modalities, cysts can be isodense in CT scans [ 8 ]; cardiac magnetic resonance (CMR) is usually obtained to clarify tissue characteristics, but blood cysts are variably observed as hyperintense in T2W [ 11 ], isointense in turbo spin echo [ 8 ], and/or with a prolonged T1 relaxation time in special breath-held inversion-recovery sequences [ 12 ].…”

“…Within the cardiac structure, they are mainly detected on valves with few cases of cysts attached to atria or ventricles [1]. Additionally, content echogenicity and intracystic microbubbles suggesting ventricle-to-cyst lumen connections [4] seem to be signs compatible with blood cysts.…”

Mitral valve blood cyst with regurgitation

“…Haemodynamically stable patients should be followed with serial echocardiographic examinations. If the mass interferes with normal cardiac function, it should be resected surgically with or without valvular replacement 2. As in our case, if there is concominant coronary artery disease, ischaemic mitral regurgitation should be considered before deciding on valvular surgery.…”