Unusual Presentation of Papillary Fibroelastoma: Utility of Serial Transesophageal Echocardiograms

Papillary fibroelastoma of the anterolateral papillary muscle: an unusual case

We describe the case of a 75-year-old female admitted to our ward with a diagnosis of papillary fibroelastoma discovered during routine control. The patient was completely asymptomatic without any previous event of embolization or valve incompetence. We report this rare case of papillary fibroelastoma for its unusual location with large involvement of the anterolateral papillary muscle (its prevalence in the literature is about 1%).

Papillary fibroelastoma of the right atrium as an unusual source of recurrent pulmonary embolism

Papillary fibroelastoma is the most common primary tumour of cardiac valves, with the potential for embolic events and obstructive effects. Location in non-valvular endocardium is extremely rare. Transthoracic and transoesophageal echocardiography have greatly increased the ability to make the diagnosis of these surgically treatable tumours in a timely fashion. We report the case of a 70-year-old woman with symptoms and ventilation-perfusion scan evidence of pulmonary embolization from a papillary fibroelastoma of the right atrium. Initial transthoracic echocardiography failed to identify the tumour, whereas transoesophageal echocardiography demonstrated a mobile echodense mass attached to the right atrial free wall. After surgical excision, histopathology revealed papillary fibroelastoma. The epidemiology, aetiology, localization, macroscopy, histopathology, immunohistochemistry, clinical presentation, diagnosis and management of cardiac papillary fibroelastoma are reviewed. The case is unusual with respect to the site of origin of the papillary fibroelastoma as well as its clinical presentation, which is clearly related to pulmonary embolization.