Incidental cardiac papillary fibroelastoma: a management dilemma

Cardiac Papillary Fibroelastoma: Atypical Presentation Mimicking Infective Endocarditis With False Positive Commensal Blood Cultures

Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac neoplasms that carry a high risk of embolization if not diagnosed and managed in a timely manner. As most patients are asymptomatic, CPF may be incidentally detected on transthoracic echocardiography (TTE) when performed for other indications. Management of incidental CPF in asymptomatic patients is debatable. We report an unusual case of an incidental CPF in an asymptomatic patient admitted to the hospital for presumed infective endocarditis (IE). Two weeks following laser resection of laryngeal cancer (LC), a new pansystolic murmur was audible during a routine cardiology visit. Outpatient TTE revealed a "vegetation-like" lesion on the mitral valve (MV). Blood cultures (BC) with Gram-positive cocci in clusters (GPC) were reported within 24 hours. This prompted hospital admission for empiric antibiotics. A transesophageal echocardiogram (TEE) confirmed the lesion to be an echogenic mass attached to the MV consistent with CPF. Repeat BC, prior to empiric antibiotic initiation, were all negative. In the absence of all other signs and symptoms of IE, it was determined that the initial BC was false positive and IE was ruled out. Surgical resection was performed due to the potential risk of embolization. The pathology confirmed the diagnosis of CPF with negative tissue cultures.

Ascending Aortic Wall Fibroelastoma in an Elderly Woman with Dyspnea

Aortic fibroelastoma is an uncommon pathology that is often found incidentally on routine cardiac imaging. The use of multimodality imaging including computerized tomography and magnetic resonance imaging has led to discovery of further distinguishing features of these lesions that may allow improved differentiation from aortic thrombi. Although most are located on cardiac valves, nonvalvular fibroelastomas have been seen on occasion. Optimal diagnosis and management of incidental aortic fibroelastomas remains debated. We describe a case of nonvalvular aortic fibroelastoma and review current diagnostic and management approaches.