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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

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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.

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Authors and Affiliations

  1. Service de Radiologie A, Hopital Cochin, 27 Rue du Faubourg St Jacques, 75014, Paris, France

    Hervé Gouya, Paul Legmann & Olivier Vignaux

  2. Paris-Descartes University, Paris, France

    Hervé Gouya, Laure Cabanes, Luc Mouthon, Paul Legmann & Olivier Vignaux

  3. INSERM U1060, Paris, France

    Luc Mouthon

  4. Pitié-Salpétrière Hospital, Paris, France

    Alain Pavie

  5. Pierre et Marie Curie University, Paris, France

    Alain Pavie

Authors
  1. Hervé Gouya
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  2. Laure Cabanes
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  3. Luc Mouthon
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  4. Alain Pavie
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  5. Paul Legmann
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  6. Olivier Vignaux
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Corresponding author

Correspondence to Hervé Gouya.

Electronic supplementary material

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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)

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Gouya, H., Cabanes, L., Mouthon, L. et al. 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. Int J Cardiovasc Imaging 30, 959–960 (2014). https://doi.org/10.1007/s10554-014-0418-8

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  • DOI: https://doi.org/10.1007/s10554-014-0418-8

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