Is That a Cardiac Mass or Just a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa?

A 64-year-old male veteran with a history of aortic valve (AV) replacement for severe bicuspid AV regurgitation from infective endocarditis was diagnosed with acute decompensated heart failure. Initial transthoracic echocardiogram evaluation demonstrated a dilated cardiomyopathy with a suspicious mass. Multimodality imaging evaluation, including cardiac computed tomography and cardiac magnetic resonance imaging, confirmed the diagnosis of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa. Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa may be a potential congenital abnormality or a rare, life-threatening complication of aortic surgery or infective endocarditis. Recognition via multimodality imaging is essential to ensure adequate treatment.