title: A rare nonvalvular left ventricular papillary fibroelastoma: A case report.
abstract: Papillary fibroelastomas are benign cardiac tumors with high embolic potential typically found on the valvular surfaces of the heart. Nonvalvular papillary fibroelastomas are exceedingly rare. We report the case of a 66-year-old Caucasian male with acute bilateral basal ganglia infarctions found to have a mass adherent to the left ventricular septum by transesophageal echocardiography. The mass was identified as a rare nonvalvular cardiac papillary fibroelastoma based on echogenicity, pedunculated nature, and typical motion. Tissue characterization by cardiac magnetic resonance imaging demonstrated homogeneously hypo-intense signal on T2 weighted imaging and signal hyperintensity after administration of gadolinium contrast, confirming the fibroelastic nature of the mass. Surgical excision was performed via ventriculotomy and histopathologic examination was pathognomonic of a papillary fibroelastoma. We conclude that transesophageal echocardiography provides high diagnostic certainty in patients with cardiac papillary fibroelastomas and can reliably identify atypical locations of these tumors on nonvalvular surfaces. A multimodality imaging approach is not necessarily indicated in all patients with this condition.
  
  
  OBJECTIVE
  Papillary fibroelastomas are benign cardiac tumors with high embolic potential typically found on the valvular surfaces of the heart. Nonvalvular papillary fibroelastomas are exceedingly rare. Transesophageal echocardiography readily identifies nonvalvular papillary fibroelastomas based on echogenicity, pedunculated nature, and characteristic motion, and reliably differentiates them from other cardiac masses. A multimodality imaging approach is not indicated in all patients with this condition.
authors.affiliation: Division of Cardiology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
authors.forename: Forum
authors.initials: F
authors.lastname: Kamdar
authors.affiliation: Division of Cardiology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
authors.forename: Sithu
authors.initials: S
authors.lastname: Win
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA.
authors.forename: J Carlos
authors.initials: JC
authors.lastname: Manivel
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, MN 55455, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Shumway
authors.affiliation: Division of Cardiology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
authors.forename: Emil
authors.initials: E
authors.lastname: Missov
keywords: Cardiac magnetic resonance imaging; Nonvalvular; Papillary fibroelastoma; Transesophageal echocardiography
references.citation: Interact Cardiovasc Thorac Surg. 2005 Aug;4(4):311-5
references.pmid: 17670419
references.citation: Hum Pathol. 2002 Dec;33(12):1165-9
references.pmid: 12514783
references.citation: Am Heart J. 2003 Sep;146(3):404-10
references.pmid: 12947356
references.citation: Ann Thorac Surg. 1999 Nov;68(5):1881-5
references.pmid: 10585089
references.citation: Ann Surg. 1980 Feb;191(2):127-38
references.pmid: 7362282
references.citation: Eur J Echocardiogr. 2007 Oct;8(5):401-3
references.pmid: 16876483
references.citation: Ann Thorac Surg. 2009 Dec;88(6):e66-7
references.pmid: 19932221