This case highlights the limitations of multimodality imaging in differentiating atypical cardiac masses and the importance of tissue diagnosis when clinically safe and feasible.
Post-AMI LV masses warrant broad differential beyond thrombus; this case leaves open optimal multimodality imaging strategies.
BACKGROUND: In the setting of an acute myocardial infarction (AMI), although the most common etiology of a left ventricular (LV) mass identified on multimodality cardiovascular imaging is a thrombus, other possibilities including a vegetation or tumor should be entertained within the differential diagnosis. CASE PRESENTATION: We describe a case of a 43-year-old Caucasian female post AMI diagnosed with a mid-cavitary mass within the LV. Although echocardiography and cardiovascular MRI (CMR) suggested that the mass was a thrombus, given the context of the recent AMI, exploration and surgical excision was completed by the surgeon due to the potential for the mass to embolize. CONCLUSION: The final diagnosis of a papillary fibroelastoma was unique due to its unusual location and large size within the LV cavity. This unique case demonstrates shortcomings of multimodality cardiac imaging in the diagnosis of an atypical mass and the importance of obtaining tissue when clinically safe and feasible.
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Sharma et al. (2017) studied this question.
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