Images from her transthoracic and transoesophageal echocardiogram showed two large (2 cm2) left atrial nodular masses; one attached to the atrial surface of the anterior mitral leaflet tip and another free-floating in the left atrium, but not causing any mitral valve obstruction (figure 1). The mitral leaflets appeared normal with no regurgitation and no masses were noted in other chambers or valves including atrial appendages. A differential diagnosis of vegetations, thrombus or tumour mass was considered. Three sets of blood cultures were negative. A thrombophilia screen demonstrated markedly raised IgG anticardiolipin, β2 glycoprotein I a
