Papillary fibroelastoma of the coumadin ridge as an unusual cause of recurrent ischemic stroke: a case report

Cardiac papillary fibroelastoma (PFE) is a rare benign endocardial tumor with significant embolic potential despite its non-malignant histology. We report the case of a 51-year-old woman with palpitations and a history of ischemic stroke involving the left medulla oblongata, accompanied by multiple posterior fossa infarcts. Extensive thrombophilic and autoimmune investigations were negative, and a patent foramen ovale was excluded. Multimodal cardiac imaging, including transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (CMR), identified a highly mobile pedunculated mass attached to the coumadin ridge near the left atrial appendage ostium. Differential diagnosis included thrombus, myxoma, and PFE. The lesion was successfully removed by surgical excision, and histopathological examination confirmed PFE. This case highlights the coumadin ridge as an exceptionally rare site of PFE attachment and a potential source of recurrent cardioembolism. TEE and CMR are crucial for diagnosis, while surgical resection provides definitive treatment.