Key result
Transesophageal echocardiography successfully identified a mobile hyperechoic structure on the aortic valve, leading to the surgical excision of an intracardiac papillary fibroelastoma in a patient with embolic stroke of undetermined source.
Case Report (n=1)
Transesophageal echocardiography is crucial for identifying rare cardiac embolic sources such as papillary fibroelastoma in patients with embolic stroke of undetermined source.
TEE may identify rare cardiac sources in select ESUS cases; leaves open whether routine use improves outcomes.
A 62-year-old woman had a prior ischemic stroke in the right temporal lobe with dysarthria and dysesthesia of the left hand. Embolic stroke of undetermined source (ESUS) was diagnosed and warfarin was administered. However, transient ischemic attack recurred upon admission to our hospital. Paroxysmal atrial fibrillation and cerebral arterial stenotic lesions were absent. Transesophageal echocardiography revealed a mobile hyperechoic structure on the aortic valve indicating papillary fibroelastoma. She was diagnosed with a brain embolism due to the intracardiac tumor which was surgically excised and pathologically confirmed as papillary fibroelastoma. This type of tumor is relatively rare but it is important as an embolic source especially in ESUS. Transesophageal echocardiography was indispensable for detecting the embolic source in this patient with ESUS.
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Ohya et al. (2016) conducted a case report in Embolic stroke of undetermined source (ESUS) / Intracardiac papillary fibroelastoma (n=1). Transesophageal echocardiography and surgical excision was evaluated on Diagnosis and treatment of intracardiac papillary fibroelastoma. Transesophageal echocardiography successfully identified a mobile hyperechoic structure on the aortic valve, leading to the surgical excision of an intracardiac papillary fibroelastoma in a patient with embolic stroke of undetermined source.
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