Papillary fibroelastoma

Perfusfind S.L.
Echocardiography Jan 1, 1970 0
It can be asymptomatic (commonly diagnosed as an incidental finding on an echocardiogram) or cause symptoms and embolize (same as atrial myxoma, the most frequent benign tumor). Characteristically, it is located on the atrial side of the mitral valve and the ventricular side of the aortic one. Macroscopically, it can be seen filiform prolongations (also very characteristic, resembles a sea anemone) and, microscopically it presents a myxoid connective tissue nucleus containing an abundant matrix of mucopolysaccharides and elastic fibers, with branching avascular papillae composed of collagen, all covered by a superficial endothelium. Surgical excision is usually curative, although treatment needs to be individualized based on size, symptoms and clinical context.   
                 
Case A is a small one and Case B a large one.
 
 

Video #1 (case A): This long axis TEE view shows a small mass with strands attached to the aortic valve cusp. Small ones like this one may confused with lambl’s excrescences which are thought to be small degenerative filiform strands commonly seen on the valves of older individuals.

 

Video #2 (case A): A short axis view shows that this is indeed a papillary fibroelastoma with a clear small mass attached to the right coronary cusp. Larger fibroelastomas, as shown in example 2 can cause symptoms and embolize more often.

 

Video #3 (case B): This example shows a larger papillary fibroelastoma in the TEE short axis view, which was symptomatic (stroke and TIA like symptoms) and had to be removed. Note that, compared to example 1, it is a more clearly visible round shaped mass attached by a stalk to the aortic valve.

Video #4 (case B): This zoomed in view shows that the fibroelastoma is attached to the left coronary cusp.

 

Video #5 (case B): A long axis view also gives a sense for the size and location of the mass, found in this case on the aortic side of the valve.

Alex : is a last year medical student, very passionate about echo, POCUS and hand-held ultrasound devices.
He posts YouTube reviews of these, as well as interesting cases in Instagram (@mastersofultrasound) and Twitter (@mastersofultrasound).
 

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