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Severe mitral stenosis as the first manifestation of systemic lupus erythematosus in a 20-year-old woman: the value of magnetic resonance imaging in the diagnosis of Libman-Sacks endocarditis

  • Hervé GouyaEmail author
  • Laure Cabanes
  • Luc Mouthon
  • Alain Pavie
  • Paul Legmann
  • Olivier Vignaux
Images in Cardiology

Abstract

We report a case of severe mitral stenosis caused by Libman-Sacks endocarditis, as an initial manifestation of systemic lupus erythematosus (SLE) in a 20-year-old woman. Cardiac magnetic resonance imaging (MRI) demonstrated a thickening of the mitral valve with basal endocardial thickening exhibiting defect on first-pass perfusion short-axis acquisition and delayed enhancement in keeping with extensive fibrous endocarditis. The patient underwent successful mechanical mitral valve replacement. This case illustrates that MRI is useful in diagnosing this recognised but uncommon cardiac complication of SLE and excluding differential diagnosis such as valve tumour and infective endocarditis with perivalvular abscesses.

Keywords

Systemic lupus erythematosus Magnetic resonance imaging Libman-Sacks endocarditis Mitral stenosis 

Notes

Conflict of interest

None.

Supplementary material

Supplementary material Movie 1. Transthoracic echocardiography. Transthoracic echocardiography showed minor hydropericardium and severe mitral stenosis due to a global thickening of the endocardium. (MPG 1488 kb)

Supplementary material Movie 2. Cardiac MRI long-axis cine. Analysis of long-axis cine views demonstrated a thickening of both the mitral valve and the surrounding endocardial tissue. (MPG 124 kb)

Supplementary material Movie 3. Cardiac MRI short-axis first-pass perfusion. First-pass perfusion short-axis acquisition showed a perfusion defect of the basal endocardium. (MPG 422 kb)

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Hervé Gouya
    • 1
    • 2
    Email author
  • Laure Cabanes
    • 2
  • Luc Mouthon
    • 2
    • 3
  • Alain Pavie
    • 4
    • 5
  • Paul Legmann
    • 1
    • 2
  • Olivier Vignaux
    • 1
    • 2
  1. 1.Service de Radiologie AHopital CochinParisFrance
  2. 2.Paris-Descartes UniversityParisFrance
  3. 3.INSERM U1060ParisFrance
  4. 4.Pitié-Salpétrière HospitalParisFrance
  5. 5.Pierre et Marie Curie UniversityParisFrance

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