Differential Diagnosis for Severe TR, Mitral Stenosis, and Abdominal Mass
Single Most Likely Diagnosis
- Constrictive pericarditis with severe tricuspid regurgitation (TR) and mitral stenosis, and an abdominal mass likely representing ascites: This diagnosis is likely because constrictive pericarditis can lead to severe TR and mitral stenosis due to the impaired filling of the heart. The abdominal mass could be ascites, which is a common finding in constrictive pericarditis due to increased venous pressure.
Other Likely Diagnoses
- Tricuspid regurgitation and mitral stenosis due to rheumatic heart disease with an abdominal mass representing a separate pathology (e.g., liver disease or a primary abdominal tumor): Rheumatic heart disease is a common cause of mitral stenosis and can also lead to TR. The abdominal mass could be unrelated to the cardiac condition.
- Right heart failure due to pulmonary hypertension with secondary TR and mitral stenosis, and an abdominal mass representing ascites or hepatomegaly: Pulmonary hypertension can lead to right heart failure, causing TR and potentially worsening mitral stenosis. The abdominal findings could be due to congestion.
Do Not Miss Diagnoses
- Cardiac tamponade: Although less likely, cardiac tamponade can present with similar symptoms, including abdominal findings if there is significant increase in venous pressure. Missing this diagnosis could be fatal.
- Infective endocarditis: This condition can cause valvular dysfunction leading to TR and mitral stenosis. An abdominal mass could represent a septic embolus or abscess. Missing infective endocarditis could lead to severe consequences.
Rare Diagnoses
- Carcinoid heart disease: This rare condition can cause TR and, less commonly, affect the mitral valve. An abdominal mass could represent a carcinoid tumor.
- Ebstein’s anomaly: A congenital heart defect that can cause severe TR. Mitral stenosis would be less common but could be present in some cases. An abdominal mass would likely be unrelated but could represent a separate congenital anomaly or a complication of the cardiac condition.
- Loeffler’s endocarditis (hypereosinophilic syndrome): A rare condition that can cause valvular dysfunction, including TR and mitral stenosis. An abdominal mass could represent eosinophilic infiltration of abdominal organs.