Mesothelial/monocytic incidental cardiac excrescences (MICE) with tubercular aortitis: report of the first case with brief review of the literature

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare and distinctive cardiac lesion composed of mesothelial and monocytic cells with other inflammatory cells and fibrin. Though the first case of MICE was reported about three decades earlier, to date fewer than 50 cases have been recorded in the available literature.1–5 We describe the case of a 40-year-old male who was admitted in the Department of Cardiothoracic and Vascular Surgery with complaints of dyspnoea (NYHA Class III) of 1 year's duration. There was no history of pedal oedema, chest pain, palpitations, syncope, neurological or embolic manifestations or signs of infective endocarditis and rheumatic fever. Clinical examination revealed absence of pallor, jaundice, cyanosis, pedal oedema, lymphadenopathy or Marfanoid features. His general condition was fair. His pulse was 88/min and regular with all peripheral pulses palpable. His blood pressure was 140/80 mmHg. There were peripheral signs of aortic regurgitation. Respiratory system examination did not reveal any abnormality. Cardiovascular examination showed apex beat in the left sixth intercostal space. The heart sounds S1 and S2 were audible with an ejection systolic murmur at the aortic area. Electrocardiogram revealed normal sinus rhythm, left axis deviation and left ventricular hypertrophy. Echocardiography revealed severe aortic regurgitation without any stenosis. The other valves were normal. There was no clot, vegetation or pericardial effusion. With a clinical diagnosis of aortic regurgitation, the patient underwent aortic valve replacement. There was mild serous pericardial effusion, adhesions between the aorta and pericardium and multiple small cystic structures containing gel-like material surrounding the ascending aorta. Cardiomegaly with left ventricular hypertrophy was noted. The right atrium, right ventricle, left atrium and left atrial appendage were unremarkable. The ascending aorta was thick and dilated, and appeared inflamed. The native aortic valve was …