Definitive diagnosis of papillary muscle rupture is made with which imaging modality?

• A. Chest X-ray
• B. Cardiac MRI
• C. Echocardiography
• D. CT angiography

Answer: (C)

Direct visualization of the mitral valve apparatus and assessment of mitral regurgitation severity make echocardiography the definitive imaging choice for papillary muscle rupture. Transthoracic echocardiography quickly shows rupture of a papillary muscle or a flail leaflet with a high-velocity MR jet, confirming the diagnosis and guiding urgent management. If image quality is limited, transesophageal echocardiography provides clearer detail and confirmation. Other imaging modalities may show consequences like edema on chest X-ray or assess anatomy differently, but they do not provide the definitive visualization of the rupture and its hemodynamic impact the way echocardiography does.