A 56-Year-Old Man with Mitral Regurgitation and Acute Pulmonary Edema: Rupture of the Papillary Muscle or Infective Endocarditis?

• Several conditions such as IE and papillary muscle rupture can cause acute MR. • A ruptured papillary muscle may in rare cases mimic an infectious vegetation. • Echocardiography can in most cases accurately diagnose the cause of MR. • Image quality should be considered in the diagnostic progression. • Papillary muscle rupture may be entangled by chordae preventing complete flail.