Tricuspid Valve Mass: Papillary Fibroelastoma or Thrombus? A Diagnostic Dilemma

Cardiac tumors, particularly papillary fibroelastomas (PFEs), often pose diagnostic challenges due to overlapping imaging characteristics with thrombi. While transthoracic and transesophageal echocardiography have high sensitivity for detecting fibroelastomas, their specificity remains limited. Tricuspid valve involvement is rare, with most cases occurring on the aortic valve. A 30-year-old male presented with exertional breathlessness for 2 months. Echocardiography revealed a mobile echogenic mass on the tricuspid valve, suggestive of PFE. Cardiac magnetic resonance imaging confirmed a non-mitotic lobulated mass, prompting surgical excision. However, histopathological examination identified the lesion as a thrombus rather than a fibroelastoma. This case underscores the importance of histopathological confirmation in differentiating between tumor and thrombus. Despite advancements in imaging, surgical excision remains a crucial approach when embolic risk is high. This report highlights the need for a multimodal diagnostic strategy to optimize patient management and reduce misdiagnosis-related complications.