A case of cerebral embolism due to papillary fibroelastoma in the coumadin ridge

Cardiac papillary fibroelastoma (CPF) is often of valvular origin, but rarely forms in coumadin ridge (CR) and may cause cerebral embolism. We present an unusual 79-year-old man with cerebral embolism caused by CPF in CR. The patient presented with right upper limb paresis and was diagnosed with left centrum ovale infarction. Atrial fibrillation and severe stenosis of the cerebral and carotid artery were not found in various examinations. Although transthoracic echocardiography showed no abnormalities, transesophageal echocardiography (TEE) revealed a mobile string-like structure measuring approximately 11 mm at the tip of the CR. We suspected a thrombus attached to the CR, and anticoagulation therapy was administered, however the structure did not disappear. Therefore, the patient was diagnosed as cardiac tumor and underwent tumor excision and surgical closure of the left atrial appendage. The tumor was confirmed to be CPF on histopathology. Warfarin therapy was continued, and there was no recurrence of tumor or cerebral embolism at 4 months after surgery. CPF should be considered in cryptogenic stroke, especially in embolic stroke of undetermined sources cerebral embolism.