PMC5667298_01
Imaging and histological findings of Case 1, a 72-year-old woman with unilateral pulmonary edema. A, Anteroposterior chest radiograph shows right-side limited infiltrates with cardiomegaly. B, Transthoracic echocardiography shows mitral valve prolapse (arrow). C, Color Doppler transesophageal echocardiography reveals severe mitral regurgitation and the regurgitant jet tending to blow rightward within the left atrium at the midesophageal two-chamber view. D, Histological findings of the mitral valve reveal fibrous thickening but no vegetation or rheumatic change. LA, left atrium; LAA, left atrial appendage; LV, left ventricle.
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The anteroposterior chest radiogram revealed right-side limited alveolar-interstitial infiltrates with cardiomegaly (Fig. 1A). However, transthoracic echocardiography revealed mitral valve prolapse with severe regurgitation without left atrial dilation (Fig. 1B). In addition, the transesophageal echocardiogram revealed that the regurgitant jet tended to blow rightward within the left atrium (Fig. 1C). The pathological and histological findings showed that the chordae tendineae of the anterior mitral leaflet were ruptured without vegetation or rheumatic change (Fig. 1D).
PMC5667298_02
Imaging and histological findings of Case 2, a 40-year-old woman with unilateral pulmonary edema. A, Anteroposterior chest radiograph shows left-side limited infiltrates without cardiomegaly. B, Transthoracic echocardiography shows mitral valve prolapse (arrow). C, Color Doppler transthoracic echocardiography reveals mitral valve prolapse with severe regurgitation and the regurgitant jet tending to blow leftward within the left atrium. D, Histological findings reveal inflammatory cells and fibrin deposition in the mitral valve, and vegetation with Gram-positive cocci infiltration (arrow). LA, left atrium; LV, left ventricle; RV, right ventricle.
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The anteroposterior chest radiograph showed left-side limited alveolar-interstitial infiltrates without cardiomegaly (Fig. 2A). Transthoracic echocardiography revealed mitral valve prolapse with severe regurgitation without left atrial dilation, and the regurgitant jet tended to blow toward the left side of the left atrium (Fig. 2B, C). The histological findings revealed inflammatory cells and fibrin deposition in the mitral valve, and vegetation with Gram-positive cocci infiltration (Fig. 2D).