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Multimodality imaging approach to identify hemodynamic significance of an anomalous papillary muscle insertion: A case report

Year: 2026

Type: article

Abstract: Anomalous papillary muscle insertion (APMI) has primarily been reported in the context of contributing to left ventricular outflow tract (LVOT) obstruction. However, there is a paucity of cases reporting APMI without LVOT obstruction. This case reports a 61-year-old female who presented with acute neurologic symptoms suggestive of cardioembolic stroke. Transthoracic and transesophageal echocardiography identified a mobile mass on the anterior mitral leaflet without significant valvular abnormality or LVOT obstruction. Cardiac MRI confirmed the diagnosis of APMI without dynamic obstruction and excluded thrombus or tumor. Given the lack of hemodynamic compromise, the patient was managed conservatively without surgical intervention or anticoagulation. This case highlights the utility of multimodality imaging in evaluating rare congenital cardiac anomalies. Cardiac MRI was essential in characterizing APMI and avoiding unnecessary surgical or pharmacologic intervention. The case adds to the limited literature on APMI without LVOT obstruction, particularly in the setting of stroke evaluation.

Source: Radiology Case Reports

DOI: 10.1016/j.radcr.2025.12.043

Authors: Som Singh, Omar Shaikh, Akshitha Yarrabothula, Simbo Chiadika

Institution: The University of Texas Health Science Center at Houston

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $600