Differential Diagnosis for Mobile Mass on Aortic Valve
The presence of a mobile mass on the aortic valve can be due to various cardiac and non-cardiac conditions. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Veggetation (Infective Endocarditis): This is often the first consideration due to its potential for severe complications and the need for prompt treatment. The mobile mass can be a vegetation, which is a collection of bacteria, platelets, and fibrin.
Other Likely Diagnoses
- Lambl's Excrescences: These are small, fibrous masses that can occur on the aortic valve, often associated with aging or valve disease. They are usually benign but can be mistaken for more serious conditions.
- Papillary Fibroelastoma: A benign tumor of the heart valves, which can appear as a mobile mass on the aortic valve. It's rare but should be considered due to its potential for embolization.
- Thrombus: A blood clot on the aortic valve can present as a mobile mass. This could be due to various conditions, including atrial fibrillation or valve disease.
Do Not Miss Diagnoses
- Marantic Endocarditis (Non-bacterial Thrombotic Endocarditis): Although less common, this condition involves the formation of sterile vegetations on the valve due to hypercoagulable states, often associated with malignancy. Missing this diagnosis could lead to significant morbidity and mortality.
- Libman-Sacks Endocarditis: Associated with systemic lupus erythematosus (SLE), this condition can cause vegetations on the valve, which might appear as a mobile mass. It's crucial not to miss this due to its association with a systemic disease requiring specific management.
Rare Diagnoses
- Metastatic Tumor: Rarely, tumors can metastasize to the heart, including the aortic valve, presenting as a mobile mass. Examples include renal cell carcinoma or melanoma.
- Myxoma: Although more commonly found in the left atrium, myxomas can very rarely occur on the aortic valve, presenting as a mobile mass. They are benign tumors but can cause obstructive symptoms or embolization.