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Case Reports
. 2025 Aug 27;30(25):104940.
doi: 10.1016/j.jaccas.2025.104940.

Left Atrial Papillary Fibroelastoma and Mediastinal Radiotherapy

Wei Jun How  1 , Trishla Patel  2 , Nadim Malik  3
Affiliations
Case Reports

Left Atrial Papillary Fibroelastoma and Mediastinal Radiotherapy

Wei Jun How et al. JACC Case Rep. .

Abstract

Background: High-dose mediastinal radiotherapy can result in progressive valvular degeneration and secondary malignancy.

Case summary: A 50-year-old woman with prior chest radiotherapy and stem cell transplantation for Hodgkin lymphoma presented with progressive exertional dyspnea. Transthoracic and transesophageal echocardiography revealed severe mitral regurgitation with mitral annular calcification and an incidental finding of a mobile 12 × 8 mm left atrial mass. The patient subsequently underwent mitral valve replacement and resection of the left atrial mass with histologic confirmation of a degenerative, fibrotic mitral valve and a papillary fibroelastoma (PFE).

Discussion: Secondary malignancy can arise after radiotherapy treatment among cancer survivors. This would have led to radiation fibrosis of the mitral valve and potential development of a PFE. Although PFEs are histologically benign and exceedingly rare, their embolic potential warrants surgical intervention.

Take-home message: Cardiac complications from mediastinal radiotherapy can manifest decades later as valvular degeneration and, occasionally, rare tumors such as PFE.

Keywords: cancer; echocardiography; mitral valve; three-dimensional imaging.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Mid-Esophageal View of the Mitral Valve on TEE
Figure 2
Figure 2
Midesophageal View of the Left Atrial Fibroelastoma on TEE
Figure 3
Figure 3
Axial Reconstruction of Computed Tomography of the Chest Heavy mitral annular calcification demonstrated on computed tomography.
See this image and copyright information in PMC

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