Incidental detection of aortic valve fibroelastomas during endoscopic ultrasound for pancreatic evaluation: Three case reports

Abstract

Background: Papillary fibroelastomas are rare, benign cardiac tumors typically found on the heart valves. This case series presents three patients with aortic valve fibroelastoma incidentally detected during endoscopic ultrasound (EUS) for pancreatic and biliary pathologies. These cases highly get the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation, raise important questions about the true prevalence of these lesions, and highlight the need for established guidelines for their management and surveillance. The detection of fibroelastomas during routine EUS procedures emphasizes the importance of thorough assessment and multidisciplinary approaches in managing unexpected discoveries. This also highlights the potential thromboembolic risks associated with fibroelastomas and challenges in determining appropriate management strategies for patients who are asymptomatic.

Case summary: The patients aged 72 years, 51 years, and 42 years underwent EUS for various indications when aortic valve lesions consistent with fibroelastomas were discovered. These findings were subsequently confirmed by transesophageal echocardiography in two cases, with the third patient awaiting assessment. The lesions ranged in size from 0.61 cm to 1.6 cm in diameter and exhibited characteristic sonographic features of fibroelastomas, including hyperechoic appearance and attachment to the aortic valve leaflets. These cases highlight the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation, raising questions about the true prevalence of fibroelastomas and the need for establishing management guidelines.

Conclusion: This case series raises important questions regarding the prevalence of aortic valve fibroelastoma lesions in the general population. This highlights the urgent need for comprehensive evidence-based guidelines to standardize the management and long-term surveillance of affected patients.

Keywords: Aortic valve lesions; Case report; Endoscopic ultrasound; Incidental cardiac findings; Papillary fibroelastoma; Thromboembolic risk; Transesophageal echocardiography.

Figure 1

Computed tomography view of the aortic valve lesion. A: Endoscopic ultrasound longitudinal; B: Endoscopic ultrasound longitudinal; C: Transesophageal echocardiography cross-sectional; D: Transesophageal echocardiography cross-sectional; E: Transesophageal echocardiography longitudinal; F: Endoscopic ultrasound longitudinal.