Key result
Surgical excision of rare LAA fibroelastoma prevents recurrent neurological deficits following successful resection.
Why the study?
Fibroelastomas are rare cardiac tumours that can cause systemic emboli and are often located on heart valves, but their presence in the left atrial appendage as a cause of cerebrovascular events is uncommon and under-recognized.
Case Report (n=1)
Transoesophageal echocardiography is crucial for detecting small, highly mobile embolic sources like fibroelastomas in unusual locations such as the left atrial appendage.
Surgical success in rare left atrial appendage fibroelastoma may guide individualized decisions; leaves open optimal echocardiography protocols for embolic sources.
Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source. LEARNING POINTS: Fibroelastomas are most commonly found on left-sided heart valves (aortic > mitral) and have the potential to cause systemic emboli associated with significant morbidity and mortality.A left atrial appendage (LAA) mass in a patient presenting with cerebrovascular events does not always represent thrombus. Uncommon aetiologies such as a cardiac tumour should be considered in the differential diagnosis.Transthoracic echocardiography (TTE) does not provide an accurate assessment of the LAA and should not be used to detect pathology within this structure. Transoesophageal echocardiography (TOE) is superior to TTE in imaging the LAA and provides a complete delineation of its anatomy. In addition, TOE can detect very small highly mobile lesions (as described in this case), which may be missed on other imaging modalities.
No takes yet. Share an insight, caveat, or question.
Mashicharan et al. (2019) conducted a case report in Fibroelastoma / Cerebrovascular events (n=1). Surgical excision was evaluated on Neurological deficits following discharge. Surgical excision of a rare left atrial appendage fibroelastoma in a 72-year-old male resulted in a good post-operative recovery with no further neurological deficits.