title: Papillary fibroelastoma of the right atrium as an unusual source of recurrent pulmonary embolism.
abstract: 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.
authors.affiliation: Divisions of Cardiovascular Surgery, Hesperia Hospital, Modena, Italy. dgabbieri@yahoo.it
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.forename: Lucilla
authors.initials: L
authors.lastname: Bavutti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Corghi
authors.forename: Fabio
authors.initials: F
authors.lastname: Zacà
authors.forename: Domenico
authors.initials: D
authors.lastname: Sarandria
authors.forename: Angelo
authors.initials: A
authors.lastname: Pierangeli
authors.forename: Italo
authors.initials: I
authors.lastname: Ghidoni
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D005350:Fibroma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006338:Heart Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D010210:Papillary Muscles / Q000473:pathology* / Q000601:surgery; D011655:Pulmonary Embolism / Q000209:etiology* / Q000601:surgery; D012008:Recurrence