A 1.4 cm x 0.5 cm cardiac papillary fibroelastoma in an 86-year-old female triggered a fatal embolic storm, demonstrating that these benign tumors can cause severe cardioembolic strokes.
Case Report (n=1)
Cardiac papillary fibroelastoma, though histologically benign, can cause fatal cardioembolic strokes in the elderly, highlighting the importance of early recognition via echocardiography.
Abstract Background Cardiac papillary fibroelastoma (CPF) is an extremely rare tumor, often asymptomatic and frequently diagnosed incidentally during autopsy, with the mean age of diagnosis around 60 years. While usually benign, CPF can have life-threatening valvular obstruction or embolization. Case Presentation An 86-year-old female with HLD and prediabetes presented with shortness of breath. She had recently been diagnosed with DVT and was on apixaban. On arrival, she was tachycardic and hypoxic. Labs showed an elevated troponin (109 ng/L, peaking at 2,932 ng/L), with a non-ischemic EKG. CT pulmonary angiography demonstrated a moderate burden of pulmonary emboli, more prominent in the left lung, with evidence of right heart strain. and a small right lower lobe infarct. As the PE was not amenable to thrombectomy, she was discharged on therapeutic doses of enoxaparin for presumed apixaban failure. She later returned with an acute-onset altered mental status. A non-contrast head CT showed a right occipital intraparenchymal hemorrhage. Her anticoagulation was reversed, and neurosurgery did not recommend any surgical intervention. A subsequent MRI, performed six hours later, revealed multifocal areas of small acute infarcts in both the cerebral and cerebellar hemispheres, consistent with an embolic event, along with a stable occipital hemorrhage. Further investigation with a TTE revealed a 1.4 cm × 0.5 cm mobile echogenic mass in the left ventricle, appearing to be attached to the papillary muscle. TEE confirmed the attachment to the sub-valvular mitral valve apparatus, highly suggestive of a CPF. A cardiac MRI was recommended for outpatient follow-up. In the absence of leukocytosis and with two negative blood cultures, infective endocarditis was deemed unlikely. The family opted against invasive surgical intervention. Her neurological function further declined, and after extensive discussions regarding her condition, she was transitioned to comfort care. Discussion CPF is the second most common benign cardiac tumor after myxoma and is often undetected until a life-threatening event occurs, such as stroke, MI, or acute PE. Echocardiography is the preferred diagnostic method, typically revealing a frond-like appearance resembling a “sea anemone,” with small, speckled lesions and stippled edges. TEE offers superior visualization, aiding in diagnosis and surgical planning. Conclusion Although histologically benign, CPF can cause serious cardioembolic strokes in the elderly population. Early recognition through echocardiography is crucial to prevent potentially fatal complications. This abstract is funded by: None
Karn et al. (Fri,) conducted a case report in Cardiac papillary fibroelastoma (n=1). A 1.4 cm x 0.5 cm cardiac papillary fibroelastoma in an 86-year-old female triggered a fatal embolic storm, demonstrating that these benign tumors can cause severe cardioembolic strokes.