Left Ventricular Papillary Fibroelastoma Presenting with Dyspnea on Exertion

Figure 1. Sagittal nonenhanced double inversion fast spin-echo cardiac MRI sequence demonstrated a hyperintense mass arising from the left ventricular free wall just below the posterior mitral valve (A). Perfusion enhancement imaging obtained 2 min after administration of intravenous (IV) gadolinium (not shown) demonstrated no early enhancement within the mass. Sagittal inversion recovery late gadolinium imaging obtained 20 min after IV gadolinium demonstrated avid enhancement of the mass adjacent to the nulled left ventricular free wall myocardium (B). Arrows denote the location of the CPF.

Figure 2. Nongated contrast-enhanced CT reconstructed in three-chamber (A), long-axis (B), and short-axis (C) planes demonstrating a mass abutting the left ventricular free wall just inferior to the posterior mitral valve annulus, which is hypodense to surrounding enhanced blood and isodense to the adjacent papillary muscle and normal myocardium. Arrows denote the location of the CPF.

Figure 3. TEE revealed a mobile echodensity seen attached to the left ventricular myocardium, located immediately apical to the posterior mitral valve leaflet and measuring 1.8 cm in the largest dimension. See Videos 1 to Video 2, Video 3, Video 4.

Figure 4. Intraoperative photo depicting a “sea anemone”–like fibroelastoma within the left ventricle. Arrow denotes the location of the CPF.

Figure 5. Histologic images (A–D) depicting avascular papillary fronds consisting of collagen lined by endothelial cells, consistent with CPF. The gross specimen (not shown) was reported as a white gelatinous mass measuring 1.5 × 1.2 × 0.8 cm.