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Case Reports
. 2023 Oct 1:204:178-182.
doi: 10.1016/j.amjcard.2023.07.030. Epub 2023 Aug 4.

Massive Mysteries

Adam Aston  1 , Michael R Harowicz  2 , John D Grizzard  3 , Wendy Bottinor  4
Affiliations
Case Reports

Massive Mysteries

Adam Aston et al. Am J Cardiol. .

Abstract

Papillary fibroelastomas are benign masses often originating from the endocardium of the aortic and mitral valves. Rarely, these neoplasms are found in areas of the heart embryonically distinct from the aortic and mitral valves. Diagnosis of a papillary fibroelastoma relies on multimodal imaging as well as histologic assessment. A case series of papillary fibroelastomas in unusual locations is presented, highlighting the role of multimodal imaging techniques in identifying these intra-cardiac masses. Differential diagnoses, imaging characteristics, histopathology, and preferred management strategies for cardiac masses are reviewed. The unique imaging qualities of cardiac masses are discussed.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no relationships with industry relevant to this research. The authors have no competing interests to declare.

Figures

Figure 1:
Figure 1:. Diagnostic Imaging
(A) Delayed enhancement magnetic resonance image 10 minutes post-contrast demonstrating a low signal intensity lesion with peripheral enhancement (B) Two chamber view on transesophageal echocardiogram demonstrating a left atrial appendage mass with protrusion into the left atrial cavity
Figure 2:
Figure 2:. Gross Pathology Specimen
Surgically removed cardiac mass from the patient measuring 2.1 cm
Figure 3:
Figure 3:. Diagnostic Imaging
(A) 4-chamber view on transthoracic echocardiogram shows an echogenic irregular mass at the lateral ridge of the left atrium, also seen on axial (B) and 2-chamber view on cardiac CT (C). On CMR, the mass was best seen on the first pass perfusion sequence (D) due to flow artifact.
Figure 4:
Figure 4:
(A) 4-chamber view on transthoracic echocardiogram showed a 1 cm echogenic mass in the left ventricle near the septum. CMR showed a 10 x 7 mm mass in the left ventricle, which was highly mobile as seen on 2-chamber systolic (B) and diastolic (D) views. The mass enhances on delayed contrast enhancement 3-chamber view on CMR (C).
Figure 5:
Figure 5:. Diagnostic Imaging
Short axis view on CMR shows a 12 x 9 mm mass in the LV apex with intermediate intensity on high inversion time sequence (A) and peripheral enhancement on delayed enhancement sequence (B, C 4-chamber black blood view).
See this image and copyright information in PMC

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