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cardiac papillary fibroelastoma

Epidemiology: - third most common benign cardiac neoplasm after cardiac myxomas & lipomas Pathology: - fibroelastoma attached to the endocardium of a cardiac valve generally left-sided (case presentation [1] attachment to mitral valve) - embolization may occur - papillary structure predisposes embolization of neoplasm fragments or attached thrombus to the coronary, systemic, or cerebrovascular systems [1] - most are small (1.2 cm x 0.9 cm average) Radiology: - echocardiogram (may be incidental finding) - may show a cardiac valve vegetation with a heterogeneous globular shape or a mobile frond-like appearance on the surface of the aortic valve or mitral valve Differential diagnosis: - atrial myxoma - larger than papillary fibroelastoma - generally associated with obstructive features - 75% arise from fossa ovalis of left atrium, not a cardiac valve - fever, weight loss may be noted [1] - a tumor 'plop' may be heard on auscultation Management: - removal of the cardiac valve vegetation [1] - papillary fibroelastoma with embolic symptoms are treated surgically - large neoplasms (> 1 cm) often treated surgically even in the absence of symptoms [1] - surveillance may be appropriate for smaller, asymptomatic lesions & those arising from right-sided valves - insufficient evidence to support antiplatelet therapy or anticoagulation [1]

General

fibroelastoma cardiac valve vegetation

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. Val-Bernal JF, Mayorga M, Garijo MF, Val D, Nistal JF. Cardiac papillary fibroelastoma: retrospective clinicopathologic study of 17 tumors with resection at a single institution and literature review. Pathol Res Pract. 2013 Apr;209(4):208-14. Review. PMID: 23455367