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We present the case of a 64-year-old man who was incidentally found to have a left atrial mass in the vicinity of the left atrial appendage. Despite adequate anticoagulation for suspected thrombus for 6 months, the appearances of the mass remained unchanged. Surgical resection was recommended to reduce the risk of embolisation and to establish a histopathological diagnosis. Despite our initial suspicions of this being a myxoma the mass was ultimately confirmed to represent a rare papillary fibroelastoma occurring on the endocardial surface of the left atrium. The current report details the multimodality imaging of this phenomenon along with the diagnostic dilemma this unusual left atrial mass initially posed. [ABSTRACT FROM AUTHOR]

Primary cardiac neoplasms are a rare, commonly benign, tumor with an approximate incidence rate of 0.02%. Papillary fibroelastoma (PFE), a common form of primary cardiac neoplasms, typically present as a mass on the aortic and mitral valves, while rarely presenting as a pulmonary valve tumor. The majority of PFEs are asymptomatic, however valvular masses can pose a significant health hazard due to their potential to fragment into the bloodstream, facilitate thrombus formation, and restrict blood flow. Due to these risks, careful resection of the mass is recommended for symptomatic patients and asymptomatic patients if the tumor is large (>1 cm), mobile, or on left-sided valves. Here we present a case of an incidental finding of a pulmonic valve papillary fibroelastoma in a 65-year-old man by transesophageal echocardiography during a coronary artery bypass graft procedure.

Papillary fibroelastoma of aortic valve is a rare benign tumor that can present with symptoms of obstruction or embolization and can be asymptomatic. The main stay of diagnosis is echocardiography. The size of the tumor affects the sensitivity of transthoracic echocardiography which can miss small size tumors. The treatment is surgical resection. Here, we report a case of papillary fibroelastoma of aortic valve that was detected intraoperatively by transesophageal echocardiography and was missed by transthoracic echocardiography in a patient undergoing coronary artery surgery. The tumor was resected successfully with preservation of aortic valve with no complication. This case highlights importance of intraoperative transesophageal echocardiography in making the diagnosis. [ABSTRACT FROM AUTHOR]

Resumen: Introducción y objetivos: El fibroelastoma papilar es un tumor cardiaco primario benigno localizado normalmente en el endocardio valvular, aunque es posible encontrarlo en otras estructuras endocárdicas. Según estudios recientes, podría ser el tumor cardiaco primario benigno más común. En un número importante de casos es asintomático, se diagnostica de manera incidental y, en caso de presentar clínica acompañante, se asocia a eventos cerebrovasculares tromboembólicos. Mostramos nuestra experiencia en el tratamiento quirúrgico del fibroelastoma papilar y se lleva a cabo una revisión bibliográfica de la literatura. Métodos: Estudio retrospectivo unicéntrico mediante le revisión de las historias clínicas de todos los pacientes diagnosticados de fibroelastoma papilar y tratados quirúrgicamente en nuestro Servicio. Resultados: Desde enero de 2016 hasta octubre de 2022 se intervinieron 14 pacientes, predominantemente varones, con una edad media de 61 ± 12,6 años. El diagnóstico se realizó en casi todos los casos mediante estudios previos a la cirugía. La mayoría de los tumores eran asintomáticos y se localizaron en la válvula aórtica. Ninguno precisó reemplazo o reparación valvular. En 5 casos (35,7%) se realizó crioablación concomitante del lecho tumoral. No hubo mortalidad quirúrgica. Tras 3,2 ± 2,22 años de seguimiento dos pacientes fallecieron de causas no cardiacas. No se han objetivado recidivas. Conclusiones: El tratamiento quirúrgico del fibroelastoma papilar es seguro y ofrece buenos resultados. La crioablación concomitante podría ser útil para conseguir una eliminación tumoral completa sin necesidad de recambio valvular, aunque es necesaria más evidencia. La realización de un registro multicéntrico permitiría un mayor conocimiento de esta patología. Abstract: Introduction and objectives: Papillary fibroelastoma is a benign primary cardiac tumor normally located in the valvular endocardium, although it can be found in other endocardial structures. According to recent studies, it could be the most common benign primary cardiac tumor. In a significant number of cases it is asymptomatic, diagnosed incidentally and, in symptomatic cases, usually they present as thromboembolic neurological events. We show our experience in the surgical treatment of papillary fibroelastoma and a review of the literature is performed. Methods: Single-center retrospective study by reviewing the medical records of all patients diagnosed with papillary fibroelastoma and surgically treated in our department. Results: From January 2016 to October 2022, 14 patients were operated on, predominantly men, with a mean age of 61 ± 12.6 years. The diagnosis was made mostly in almost all cases during the preoperative study for other indications. Most of the tumors were asymptomatic and were located in the aortic valve. No patient required valve replacement or repair. In 5 cases (35.7%) concomitant cryoablation was performed. There was no surgical mortality. After 3.2 ± 2.22 years of follow-up, two patients died of non-cardiac causes. No tumoral recurrences have been found. Conclusions: Surgical treatment of papillary fibroelastoma is safe and offers good short and mid-term results. Concomitant cryoablation might be useful to achieve complete tumor removal without the need for valve replacement, however more evidence is mandatory. The realization of a multicenter registry would allow a better knowledge of this tumors.

Abstract Background It is very common for patients with newly diagnosed lung masses to have heart disease. However, papillary fibroelastomas (PFEs) of the tricuspid valve (TV) combined with lung cancer are rarely reported. It is thus unclear whether a two-stage surgery or concomitant surgery is optimal. Case presentation We report the case of a 73-year-old Chinese male who was diagnosed with PFEs on the TV by transthoracic echocardiography (TTE) examination while being evaluated to undergo video-assisted thoracic surgery (VATS) for a right lower lung nodule. We resected both the PFEs and the lung nodule via right minithoracotomy. The surgery was uneventful, and histopathology reports confirmed PFEs of the TV and moderately to poorly differentiated squamous cell carcinoma. The patient recovered uneventfully, and there was no sign of tumor recurrence during 15 months of follow-up. Conclusions We suggest that after careful evaluation, concomitant minimally invasive radical resection of primary lung cancer after cardiac PFE removal is an acceptable and safe treatment strategy and should be performed as soon as possible.

Background: It is very common for patients with newly diagnosed lung masses to have heart disease. However, papillary fibroelastomas (PFEs) of the tricuspid valve (TV) combined with lung cancer are rarely reported. It is thus unclear whether a two-stage surgery or concomitant surgery is optimal. Case presentation: We report the case of a 73-year-old Chinese male who was diagnosed with PFEs on the TV by transthoracic echocardiography (TTE) examination while being evaluated to undergo video-assisted thoracic surgery (VATS) for a right lower lung nodule. We resected both the PFEs and the lung nodule via right minithoracotomy. The surgery was uneventful, and histopathology reports confirmed PFEs of the TV and moderately to poorly differentiated squamous cell carcinoma. The patient recovered uneventfully, and there was no sign of tumor recurrence during 15 months of follow-up. Conclusions: We suggest that after careful evaluation, concomitant minimally invasive radical resection of primary lung cancer after cardiac PFE removal is an acceptable and safe treatment strategy and should be performed as soon as possible. [ABSTRACT FROM AUTHOR]

Fibroelastoma is a rare cardiac tumor that can cause embolization, stroke, myocardial infarction, heart failure, and cardiac arrest. Here, we report the case of a 45-year-old male who presented with right-sided weakness and fever. He was diagnosed with acute right frontal infarction and was found to have Streptococcus sanguinis bacteremia. Upon confirmation of a positive blood culture after 24 hours, treatment for endocarditis was initiated. Transesophageal echocardiography revealed findings highly suggestive of a papillary fibroelastoma (PFE). PFE ought to be regarded as a potential differential diagnosis in individuals who exhibit symptoms of fever, thromboembolism, and persistent bacteremia. Non-invasive imaging such as echocardiography is of great value in the diagnosis of PFE, while surgical resection remains the best treatment modality to overcome current and future associated complications. [ABSTRACT FROM AUTHOR]

The article in Acta Cardiologica discusses a rare case of a right-sided papillary fibroelastoma originating from the tricuspid valve in a 31-year-old male. The patient underwent successful surgical resection of the tumor, which was confirmed to be a papillary fibroelastoma through microscopic examination. The article highlights the rarity of this type of tumor and emphasizes the importance of prompt and accurate diagnosis for effective management. The study underscores the need for further research on the management of right-sided papillary fibroelastomas to improve patient outcomes. [Extracted from the article]

Herein, we present a rare case of papillary fibroelastoma of the aortic valve, which caused severe aortic stenosis. The papillary fibroelastoma developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure. The patient underwent an urgent surgical treatment, which resulted in a successful outcome. To the best of our knowledge, this is the first case of papillary fibroelastoma in which aortic stenosis was so severe as to cause congestive heart failure. Papillary fibroelastoma (PFE) is the most commonly observed primary cardiac tumor in adults that commonly involves left heart chambers. While PFEs often cause embolisms, they rarely cause valvular dysfunction. In a case presented herein, a PFE developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiac papillary fibroelastoma (PFE) is a rare tumor, and especially rare when found on the pulmonary valve. Case presentation We report the case of a 70-year-old woman patient with a pulmonary valve PFE diagnosed incidentally during a follow-up of aortic regurgitation. Computed tomography and magnetic resonance imaging showed no suggestive signs of malignant tumors, and thrombus or myxoma was initially suspected. However, an initial transthoracic and transesophageal echocardiogram did not exclude the possibility of a malignant tumor attached to the wall of the pulmonary artery. Considering the embolization risk, we opted to perform tumorectomy, in which additional surgical procedures could then be conducted if intraoperative diagnosis showed a malignant tumor. Indeed, intraoperative findings showed the tumoral mass attached on the left semilunar cusp of the pulmonary valve, and intraoperative diagnosis of the tumor showed no malignancy. Planned tumorectomy was performed concomitantly with AVR. The pathologic examination of the removed tumor confirmed the diagnosis of PFE. Her postoperative course was uneventful without any sign of recurrence. Conclusion This case highlights the difficulty of accurate diagnostic imaging and provides valuable insight into a successful surgical treatment of pulmonary valve PFE without any complications.

Background Papillary fibroelastomas (PFEs) are uncommon primary cardiac tumours and their recurrence after resection is rare. Case summary A 32-year-old woman, who was evaluated for recurrent embolic stroke, was found to have lesions on mitral leaflets on echocardiography. The mitral leaflets were otherwise normal with no clinical or laboratory evidence of infective endocarditis. Transthoracic, as well as transesophageal echocardiography, revealed masses on mitral leaflets, which remained almost the same over 3 years. A tentative diagnosis of PFE on the mitral valve was made. She had undergone intra-cardiac excision of mitral valve mass along with ring annuloplasty in February 2020. In November 2021, during her regular follow-up visit, transthoracic echocardiography revealed the recurrence of the masses on mitral leaflets with severe mitral regurgitation. She underwent mitral valve replacement and excision of tumour masses. Histopathological examination confirmed the diagnosis of recurrent PFE. Discussion Recurrence of PFEs is rare. We report a rare case of histologically proven recurrence of PFE of the mitral valve. This highlights the importance of routine post-operative echocardiographic follow-up in patients with PFE. [ABSTRACT FROM AUTHOR]

Papillary fibroelastomas (PFEs) followed by cardiac myxomas (CM) are the 2 most common primary benign cardiac tumors. Although typically asymptomatic, they can manifest with nonspecific symptoms such as dyspnea and dizziness or more acute manifestations such as embolic events. We describe an unusual location of a PFE typically seen with a CM. A 66-year-old woman presented with shortness of breath and dizziness. An echocardiogram revealed a left atrial mass suggestive of a CM, which was surgically removed. Histopathologic examination surprisingly confirmed it to be a PFE. This case highlights the importance of considering PFEs in the differential diagnosis of atrial masses because they can mimic CM clinically and radiographically, thus emphasizing the role of histopathologic examination for definitive diagnosis., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2025 The Authors.)

This case presents a 69-year-old woman with a previous history of arterial hypertension. A transthoracic echocardiogram was requested in the context of shortness of breath with great exercise. Incidentally, at the aortic valve level, a mobile mass suggestive of papillary fibroelastoma was visualized. Therefore, a complementary transoesophageal echocardiogram was performed., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

This report discusses the case of a 57-year-old woman with a history of breast cancer and gastric cancer, germline CDH1 gene mutation, who presented to the hospital with syncope. Diagnostic workup revealed a mass in the right ventricular outflow tract. Transcatheter biopsy suggested papillary fibroelastoma, which was confirmed with surgical pathology. This case highlights an atypical presentation of papillary fibroelastoma, which was successfully managed through a multidisciplinary approach., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The etiology of cardiac masses is often oncological or thrombotic, rarely inflammatory. Among heart tumors, the vast majority are metastatic. We describe the most frequent benign primary cardiac tumors and the most frequent malignant primary cardiac tumors and give information about the advantages of using a multi-modality approach for the accurate diagnosis of a cardiac mass using Computed Tomography Scanner and Magnetic Resonance Investigation. [ABSTRACT FROM AUTHOR]

Background Benign cardiac tumours are infrequent in clinical practice and, of these, cardiac myxoma is the one with the highest incidence. Given that a left intraventricular presentation is rare, other differential diagnoses such as papillary fibroelastoma should be considered. Case summary A 73-year-old woman patient with cardiac mass detected in transthoracic echocardiography (TTE) after a transient ischaemic attack. At TTE 2D–3D, a left intraventricular mass anchored at the level of the anterolateral papillary muscle was detected. Subsequently, cardiac magnetic resonance (CMR) was performed for mass characterization. This revealed behaviour in T1 (isointense with respect to myocardium), T2 (hyperintense), very prolonged T1-mapping (1848 msg), and T2-mapping (161 msg) values, without gadolinium uptake in the first-pass perfusion sequence, but with intense uptake in late enhancement sequences. Previous findings were compatible with a diagnosis of papillary fibroelastoma. The mass was resected intraoperatively and, although its macroscopic appearance pointed to a diagnosis of cardiac myxoma, it was finally confirmed to be a papillary fibroelastoma by pathological anatomy. Discussion In cases where the size of the mass and its mobility allow tissue characterization by CMR, a diagnosis of papillary fibroelastoma and its differentiation with cardiac myxoma are feasible by this cardiac imaging technique. [ABSTRACT FROM AUTHOR]

Background: Cardiac papillary fibroelastoma (PFE) is a rare tumor, and especially rare when found on the pulmonary valve. Case presentation: We report the case of a 70-year-old woman patient with a pulmonary valve PFE diagnosed incidentally during a follow-up of aortic regurgitation. Computed tomography and magnetic resonance imaging showed no suggestive signs of malignant tumors, and thrombus or myxoma was initially suspected. However, an initial transthoracic and transesophageal echocardiogram did not exclude the possibility of a malignant tumor attached to the wall of the pulmonary artery. Considering the embolization risk, we opted to perform tumorectomy, in which additional surgical procedures could then be conducted if intraoperative diagnosis showed a malignant tumor. Indeed, intraoperative findings showed the tumoral mass attached on the left semilunar cusp of the pulmonary valve, and intraoperative diagnosis of the tumor showed no malignancy. Planned tumorectomy was performed concomitantly with AVR. The pathologic examination of the removed tumor confirmed the diagnosis of PFE. Her postoperative course was uneventful without any sign of recurrence. Conclusion: This case highlights the difficulty of accurate diagnostic imaging and provides valuable insight into a successful surgical treatment of pulmonary valve PFE without any complications. [ABSTRACT FROM AUTHOR]

Papillary fibroelastomas (PFE) are benign neoplasms, mostly located on valvular surfaces with high embolic potential. This study presents a 27-year single institutional experience on surgical treatment of PFE in an adult patient- cohort with long-term follow-up. This study was approved by the institutional review board. Date and number of IRB approval: 11/23/2017, Institutional Review Board approval number A2014-0149. The need for individual patient consent was waived. We retrospectively evaluated all patients who underwent cardiac surgery for suspected space-occupying lesions in the observation period between June 1991 and June 2018 at our hospital. Clinicopathological features, imaging characteristics, surgical procedures and disease outcome were analyzed. 120 patients were diagnosed with various primary/secondary cardiac tumors and histology confirmed 21 PFEs were found in 16 patients. There was no significant age difference between patients with valvular vs nonvalvular PFEs (P = 0.26). Valvular lesions were found in aortic valve (n = 6), mitral valve (n = 2) and tricuspid valve (n = 1). Nonvalvular PFEs were found in right atrium (n = 2), left ventricle (n = 2), left atrial appendage (n = 2) and aortic wall (n = 1). Valvular lesions were significantly smaller in size compared to non-valvular lesions (P = 0.0013). Left-side PFEs were associated with a high embolization episodes (10/13 patients, 77%) not related to the size. One patient died in-hospital. All other patients were discharged out of the hospital postoperative. Follow-up was performed regularly for a median of 2.8 years (range 0.1-11 years) postoperative. Nonvalvular PFE tended to be larger in size and at least when located on the left sided heart had equally high propensity to embolize compared to valvular PFE. We strongly advocate surgical excision in all left-sided PFE. [ABSTRACT FROM AUTHOR]

Abstract Background Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. Case presentation We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. Conclusion Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

Papillary fibroelastoma (PFE) is one of the most common tumour of heart valves and found to be second common primary cardiac tumour. Only less than 50 cases were reported in the literature( Remadi et al., 2004) .1 Due to the advancement in 3D echocardiography, its diagnosis in living patient is become easy. The PFE could be found on both ventricles, valvular leaflets, and chordae tendinea. We present an interesting case of the CPF originating from the posterior mitral leaflet confusing with vegetation or annular calcification. Successful surgical excision was done of the papillary fibroelastoma.

Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses.

Background: Papillary fibroelastoma (PFE) is an uncommon benign cardiac tumor, typically arising from valvular structures. Nonvalvular PFEs are exceedingly rare and may present with diverse symptoms., Case Presentation: We present a case of a 46-year-old woman with positional vertigo and exertional dyspnea. Transthoracic echocardiography revealed a mobile oval-shaped mass in the left ventricle. Cardiac magnetic resonance imaging suggested a large papillary fibroelastoma. The tumor was successfully resected, and histopathological examination confirmed the diagnosis., Conclusion: This case highlights the importance of thorough imaging and surgical intervention in managing large, nonvalvular PFEs, which, although rare, can lead to significant complications., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (© 2024 Saudi Heart Association.)

Papillary fibroelastoma (PFE) is a rare, slow-growing cardiac tumor. We encountered an 80-year-old man with PFE accidentally revealed by transthoracic echocardiography (TTE) to evaluate cardiac function before a non-cardiac operation. A 10-mm mass lesion adhered to the anterior papillary muscle of the left ventricle, which had not been detected with TTE performed nine months before. Emergency cardiac surgery to remove the mass was performed, and the mass was diagnosed as a PFE. The PFE grew to 10 mm in a maximum of 9 months; to our knowledge, this is the fastest growth of PFE in the left ventricle reported to date. Papillary fibroelastoma (PFE) is a rare, slow-growing cardiac tumor. The surgical indication of PFE is sometimes controversial. The rapid growth of PFE might be considered as a criterion for surgery because this might result in the rapid progression of symptoms and complications. [ABSTRACT FROM AUTHOR]

Papillary fibroelastoma (PFE) are one of the most common primary cardiac neoplasms. They are most commonly found on cardiac valves especially on the left side of the heart and have been associated with an increased risk of embolization. To date, no large studies looked at the clinical significance of right-sided PFE (R-PFE). Therefore, we sought to better characterize patients with R-PFE and its clinical sequelae. We retrospectively identified patients with pathology-proven PFEs at a single center between January 1995 and December 2018 (n = 279). Patients with R-PFE were analyzed. Medical records and echocardiograms were reviewed for clinical and PFE characteristics. Twenty-nine patients with R-PFE (mean age 70 ± 11 years; 62% women) were included in the analysis. PFEs were located on the right atrial (RA) wall in 31%, tricuspid valve in 34%, right ventricular (RV) wall in 7%, RV outflow tract in 4%, and pulmonary valve in 10% of patients. The remaining patients (14%) had multifocal PFEs. Around 38% of patients had cancer diagnosed before PFE diagnosis, and 34% had associated congenital heart disease. Seventeen (59%) patients had angina or dyspnea at the time of the presentation, and 3 (10%) had embolic symptoms. One patient with PFE located on the RA with associated patent foramen ovale had a stroke at time of presentation. Two patients, one with PFE on the RA wall and another patient with PFE at the tricuspid valve, had pulmonary embolism at the time of presentation. Median maximal length for PFE varied by location, ranging from a media of 8 mm to 16 mm. Of the 12 patients with follow up echocardiogram 1 year after PFE removal; 3/12 (25%) had documented PFE recurrence. R-PFE can be present in patients thromboembolic events when there is a right-to-left shunt. They can be a rare cause of pulmonary embolism, and at least in those that had follow-up echocardiograms, had a significant recurrence rate. • Right-sided PFE can have various serious clinical presentations. • Right-sided PFE can be a cause of systemic emboli if associated with a shunt. • Surgical removal provides an excellent management approach. [ABSTRACT FROM AUTHOR]

Cardiac papillary fibroelastoma is a rare, benign tumour, arising from the valvular endocardium, which could lead to life-threatening complications as myocardial ischemia. We report a case of a 54-year-old male patient who presented in the emergency room with an acute coronary syndrome with transient ST segment elevation. After ruling out coronary artery disease by coronarography, we established the diagnosis of papillary fibroelastoma by performing echocardiogram completed by computed tomography angiography. The reversible acute coronary syndrome has been caused by the prolapse of pedunculated coronary cusp tumour into the main left coronary ostium. The patient was scheduled for emergent surgery. The surgical management included a complete resection of the tumour sparing the aortic valve. The patient recovered well. A papillary fibroelastoma of the aortic valve can be revealed by an acute coronary syndrome with transient ST segment elevation. More investigations must be done to eliminate such diagnosis in the case of a normal coronarography. [ABSTRACT FROM AUTHOR]

Background: Cardiac fibroelastomas are exceedingly rare etiologies of stroke, increasingly recognized with better diagnostic modalities. Surgical excision is the only curative option; however, timing of heparinization for cardiac bypass remains a challenging decision. Objective: We present a case of a 56-year-old female, diagnosed with multiple posterior circulation strokes and a left atrial mass, who successfully underwent anticoagulation and resection in 1 week. Material and Methods: MRI of the brain demonstrated numerous embolic-looking posterior circulation strokes. Transthoracic echo was negative for atrial pathology; a transesophageal echo revealed a left atrial mass, histologically consistent with papillary fibroelastoma. Results: Resection was delayed for up to 1 week to allow safe heparinization. We present a unique case of embolic stroke of undetermined source (ESUS) arising from a histologically rare tumor. Conclusion: We make the case for extensive workup for evaluation of posterior circulation strokes, including TEE, as well as timely resection of cardiac tumors. [ABSTRACT FROM AUTHOR]

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Papillary fibroelastoma (PFE) is a cardiac tumor that is mainly found on the heart valve and the endocardium of the atria and ventricles. Symptoms such as stroke and myocardial infarction are usually caused by embolization of either the tumor itself or associated thrombus. PFE is known to originate mainly from the left side of the heart, and these cases are—in principle—candidates for surgical resection. On the other hand, cases in which PFE originates from the right side of the heart are rare and reports are limited; thus, the surgical indication is unclear. We herein report a case of symptomatic PFE originating from the tricuspid valve of the heart. In this case, contrast enhanced computed tomography did not show pulmonary embolism; however, lung perfusion scintigraphy showed multiple perfusion defects. The patient was treated by anticoagulant therapy followed by surgical resection. Thereafter, the symptoms disappeared and the multiple perfusion defects improved on lung perfusion scintigraphy, demonstrating the efficacy of the anticoagulant therapy and surgical resection for PFE in the right side of the heart. < Learning objective: Papillary fibroelastoma (PFE) originating from the tricuspid valve of the heart is rare and reports on this topic are limited. Thus, the surgical indication is unclear. In the present case, lung perfusion scintigraphy indicated pulmonary embolism due to PFE, while contrast enhanced computed tomography did not. Anticoagulant therapy and subsequent surgical resection were considered effective for PFE in the right side of the heart.> [ABSTRACT FROM AUTHOR]

Introduction: Benign cardiac tumors and tumor like conditions are a heterogeneous collection of mass lesions that vary widely in their characteristics, such as presentation, size, and location. In some instances, these tumors are found incidentally, and therefore a broad differential diagnosis should be considered.Case: An elderly male with significant unintentional weight loss and a high risk for cancer presented with an incidental valvular cardiac mass. The mass was thought to be a non-bacterial thromboendocarditis on initial clinical evaluation. After multiple imaging modalities, the mass was suspected to be a papillary fibroelastoma (PFE), which was resected due to high stroke risk and multiple previous chronic infarcts on brain MRI.Conclusion: This case highlights the need for a comprehensive cardiac evaluation of a valvular tumor to discern the etiology and rule out other underlying pathophysiological processes that may require alternative interventions to cardiac surgery.

We present the case of a 75‐year‐old woman with typical myocardial infarction but a negative coronary angiogram. Echocardiography identified the rare cause of her chest pain: a mobile mass on the aortic valve that obstructed the coronary ostium. The histopathology revealed a papillary fibroelastoma (PFE), and her chest pain was relieved after surgical resection of the mass. [ABSTRACT FROM AUTHOR]

Introduction: Primary cardiac tumors are rarely seen in the general population and only a subset are classified as cardiac papillary fibroelastoma. Case Presentation: A 59-year-old female that presented for unresponsiveness and cardiac arrest required 4 rounds of cardiopulmonary resuscitation and intubation. Laboratory investigations showed uncompensated respiratory acidosis, hyperkalemia, and elevated troponins. A chest computed tomography angiogram illustrated an acute right pulmonary embolism and a right atrial filling defect. Furthermore, an echocardiogram demonstrated a normal ejection fraction and a large, pedunculated, mobile, and non-valvular echodensity that was attached to the right atrium endocardium. Therefore, the patient was started on a heparin infusion and catheter-directed thrombolysis; however, the mass persisted. A surgical excision was performed, and a 40 mm was removed. The patient was diagnosed with a papillary fibroelastoma based on the clinical symptoms, imaging, and histological findings. Conclusion: This patient's papillary fibroelastoma had multiple rare features including right atrial origin, large size, non-valvular location, and developed symptoms. Although this disease can be initially fatal, the patients typically have a favorable prognosis after a successful excision. [ABSTRACT FROM AUTHOR]

Papillary fibroelastomas (PFE) are rare primary cardiac tumors characterized by non-malignant, pedunculated, endocardial lesions with a significant risk of embolic potential and death. With improvements in the imaging quality and availability of transthoracic echocardiograms (TTE), the diagnosis of PFE has become more common in the last 2 decades. PFE is changing from a rare "zebra" diagnosis to one that community providers will encounter in their practice and must appropriately treat to prevent morbidity and mortality. Data shows that there are significant survival and morbidity benefit associated with surgical excision over non-operative management, with the benefit of anticoagulation remaining unclear at this time. We report a case describing the diagnostic workup and management of a 58-year-old woman who presented with an unidentified endocardial mass determined to be a PFE. Based on current literature, we favor a strategy of early surgical excision of PFE for an optimal reduction in mortality and thromboembolic sequelae associated with this pathology. [ABSTRACT FROM AUTHOR]

Papillary fibroelastomas are a rare cardiac neoplasm typically found on the left side of the heart, and most commonly on the aortic valve, which can present with cardiac or neurologic symptoms. A 51-year-old woman with no cardiac history presented to a resident clinic with complaints of left-sided facial paresthesias and palpitations for 1 month. Echocardiographic imaging showed a mass on the aortic annulus, concerning for a cardiac tumor. Due to the risk of possible embolization, if the tumor was a myxoma, the patient required intrathoracic surgery. During the intrathoracic procedure the mass was confirmed to be a papillary fibroelastoma and the patient had the mass removed without any complications. Papillary fibroelastomas are found in less than 1% of the population but can present clinically with a wide variety of symptoms. Patients with this neoplasm are at risk for severe complications, due to embolization, potentially causing cerebrovascular accidents or myocardial infarctions. We present a case of a papillary fibroelastoma producing both cardiac and neurologic symptoms.

Abstract Papillary fibroelastomas have a range of clinical presentations. The surgical removal of these tumors should always be considered as best alternative to a conservative approach.

Papillary fibroelastomas (PFs) are small and pedunculated left side valves associated mass, that frequently causing cerebral embolization. We present the case of a 69‑year‑old male with a history of multiple ischemic strokes and a small pedunculated mass in the left ventricle outflow tract, highly suggestive of a rare case of PF in an atypical localization. Due to the clinical history and the echocardiographic aspect of the mass, he underwent surgical excision and Bentall intervention for concomitant aortic root and ascending aorta aneurysm. The pathological analysis of the surgical specimen confirmed the diagnosis of PF. [ABSTRACT FROM AUTHOR]

Papillary fibroelastomas (PFEs) are the most common valvular tumor, typically occurring on left-sided valves. We describe the evaluation and treatment of a giant tricuspid PFE in a healthy 43-year-old police officer who was referred for evaluation of frequent premature ventricular contractions during job-related treadmill stress testing. (Level of Difficulty: Beginner.)