This case highlights the diagnostic and therapeutic challenges of a large Lambl's excrescence presenting with acute myocardial infarction and two-vessel occlusion.
May warrant surgical excision for suspected embolic LE post-MI; leaves open reliable histologic differentiation from papillary fibroelastoma.
A 59-year-old man underwent an echocardiography study after myocardial infarction and it showed a thin, mobile mass attached to the aortic valve. A diagnosis of Lambl's excrescence (LE) was suspected. Coronary occlusion as a consequence of embolism of LE's material could not be excluded and the patient underwent surgical excision. Histology confirmed the diagnosis; however a differential diagnosis with papillary fibroelastoma could not be established because both of these structures are histologically indistinguishable. A brief survey of the literature is presented. Evidence-based recommendations for treatment have not been established yet.
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Pizzuti et al. (2016) studied this question.
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