Papillary fibroelastoma mimicking vegetation of the mitral valve

Multi-organ embolism caused by oscillating aortic valve vegetation: A case report

INTRODUCTION

Valvular vegetation is often due to rheumatic heart disease and infective endocarditis. However, multi-arterial embolism can happen in older patients with no history of infection, fever, and cardiac symptoms. We describe a case of multi-organ embolism caused by oscillating aortal valve vegetation.

PATIENT CONCERNS

An 80-year-old woman without a history of infection, fever, and heart symptoms showed sudden loss of consciousness and symptoms of a multi-vessel embolism. Magnetic resonance imaging revealed multiple patchy ischemic foci in both cerebral hemispheres in the same time-phase, and echocardiography showed regurgitation in the aortic valve due to an abnormally hypo-hyperechoic mass measuring about 7.7 × 17.2 mm and oscillating aortic valve vegetation, which was induced by cardiac contraction.

DIAGNOSIS

Multiple organ cardiac embolisms caused by oscillating aortic valve vegetation.

INTERVENTIONS

Anti-platelet, fluid-supplement, and vascular-dilating therapies as well as intravenous diazepam were given to the patient.

OUTCOME

The patient died of epileptic attack secondary to the cerebral embolism.

CONCLUSIONS

The patient's whole-body multi-vessel ischemic events in nearly the same time-phase should have encouraged us to consider the possibility of cardiogenic embolism and thus early examination and treatment, although she was old with a relatively poor response due to early infection and physical discomfort. Clinicians should be aware that aortic valve vegetation induces generalized multi-organ embolism in the setting of infective endocarditis in order to ensure prompt recognition and treatment of this fatal complication.

Brain abscess complicating ischemic embolic stroke in a patient with cardiac papillary fibroelastoma - Case report and literature review

A 72-year-old man without obvious risk factors initially presented with acute ischemic stroke and fever, without concomitant infection. Broad spectrum antibiotic therapy was initiated. Transthoracic and Transesophageal echocardiography, and cardiac MRI revealed a 20 mm round mass attached to the anterior mitral valve leaflet, suggesting the diagnosis of a benign cardiac tumor or a vegetation. At the site of infarction an abscess of 11 mm in diameter developed 30 days later. The patient underwent surgical valve repair for the prevention of further embolic complications. Histology revealed a cardiac papillary fibroelastoma (PFE). He made complete clinical recovery. Secondary abscess formation after ischemic stroke is rare: 11 other cases have been reported. Because they develop at the site of a previous ischemic infarct, these abscesses usually do not manifest by additional neurologic deficits, making difficult their diagnosis. In most cases a concomitant infection cannot be individualized. Even if these abscesses are a rare entity, patients with cerebral infarct presenting with fever must be closely follow-up with cerebral imaging. Even if PFE is a rare cardiac source of embolic stroke, it should be considered in the differential diagnosis of stroke in a patient where an alternative etiology has not been established.

Papillary fibroelastoma, unusual cause of stroke in a young man: a case report

BACKGROUND

Papillary fibroelastoma is the third most common primary benign tumor with an incidence of up to 0.33% in autopsy series; it accounts for approximately 75% of all cardiac valvular tumors.

CASE PRESENTATION

We describe a rare case of a 28-Year-old man that while playing football, had a sudden onset of neurological deficit: aphasia, right hemiparesis and right facial numbness. Transthoracic echocardiography (TTE) showed a 10x10 mm mass attached to the anterior mitral valve leaflet. The patient was treated surgically for the prevention of further embolic complications. Histologic examination of the resected mass revealed a papillary fibroelastoma. It is the third most frequent primary cardiac tumor, after myxoma and fibroma, and the most common primary tumor of heart valves. Despite the benign nature of this tumor, it carries very high risk of embolic complications. The successful complete resection of the papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent.

CONCLUSIONS

Differential diagnosis of cardiac masses requires clinical informations, laboratory tests, blood cultures and appropriate use of imaging modalities. Papillary fibroelastoma is a potential cause of embolic stroke in the young. The prompt surgical excision of papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent.

Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

•

The papillary fibroelastoma is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves.

•

When clinical conditions support the presence of infection, the papillary fibroelastoma may be misdiagnosed as a vegetation due to endocarditis.

•

The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences.

•

Careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.

•

Immediate surgical removal and valve repair or replacement are the procedure of choice.

Introduction

The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves.

Case presentation

We describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast’s surgery. A preoperative echocardiography demonstrated a mass >1 cm² originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE.

Discussion

With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences.

Conclusion

To summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.

Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the most frequently found tumor occurring in the cardiac valves. With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. The PFEs have been found most often on valve leaflets, chordae tendineae, and both ventricles. We describe an interesting case of the PFE originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE.

Papillary fibroelastomas of the aortic and tricuspid valves mimicking vegetations in a patient with Turner syndrome

A patient with Turner syndrome presented with shortness of breath with exertion. Three-dimensional transesophageal echocardiogram revealed a bicuspid aortic valve with severe aortic stenosis. There were multiple masses attached to the aortic valve and tricuspid valve, which mimicked vegetations. The patient underwent aortic and tricuspid valve replacement. Histology revealed papillary fibroelastomas of the aortic and tricuspid valves. To our knowledge, this is the first report of papillary fibroelastomas involving the left- and the right-sided valves in a patient with Turner syndrome.