Multimodal imaging of papillary fibroelastoma

Figures

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  Figure 1. Echocardiography. (A) TEE, Volume rendering, transillumination. Long axis, zoom in on the LVOT. Bilobed tumour implanted in the left ventricular outflow tract (white arrows) 10 mm from the aortic valve level (dashed arrow). (B) Continuation of (A) Volume rendering, transillumination. Zoom in on the left ventricular outflow tract in short axis, viewed from the distal outflow tract. Multi-lobed tumour occupying approximately one-third of the corresponding transverse plane. (C) TEE, Volume rendering. Zoom in on the aortic root, superior view. Multiple multi-lobed tumours on the aortic cusps (dashed circle). (D) Continuation of C. TEE, Multi-planar reconstruction of case C. Aortic root in short axis. Lobes located on the three aortic cusps are quantified and measured. (E) 2D TTE. Four-chamber view. Single ovoid tumour at the apex of the left ventricle (white arrow). (F) Continuation of (E) TTE, Volume rendering. Four-chamber view. Pedunculated tumour at the ventricular apex (asterisk). (G) Macroscopic view of tumour removed from the same patient. Ovoid mass with a gelatinous surface and a solid central body, 13 mm in its largest diameter. LVOT, left ventricular outflow tract; AORT,…

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  Figure 2. Multimodal image. (A) TEE, Volume rendering, transillumination. Long axis, zoom on the aortic root. Three tumours arising from the right coronary cusp and non-coronary cusp (white arrows). (B) 2D TEE. Long axis, zoom on the aortic root. The distal portion of the tumour obstructs the ostium of the right coronary artery during systole (white arrow). (C) Three-chamber cardiac CT. A hypodense small mass with a thin stalk and multiple frond-like projections arising from the aortic side of the non-coronary cusp (white arrow). These findings are characteristic of papillary fibroelastoma. (D) 3D rendering CT. Demonstrates a pedunculated, rounded mass with greater precision of its anatomical relationships in the aortic sinuses (white arrow). (E) CMR SSFP. A hyperintense mass on T2-weighted sequences (white arrow). (F) CMR, LGE. Gadolinium enhancement of marginal ring pattern (white arrow). LVOT, left ventricular outflow tract; AORT, aorta; LV, left ventricle.

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  Figura 3. Imagen multimodal. (A) 2D TTE. Four cameras. Ovoid mass with irregular edges on the ventricular side of the anterior mitral leaflet (white arrow). (B) 2D TTE. Three cameras. Same mass with a more multi-lobulated appearance (white arrow). (C) CMR, Four-chamber SSFP. A small, rounded mass arising from the ventricular side of the mid-anterior mitral leaflet (white arrow). (D) CMR, Short-axis T1w. A small, isointense ovoid lesion arising from the A2 scallop (asterisk). (E) CMR, Four-chamber T2w demonstrated a small, high signal intensity mass (white arrow). (F) CMR, T2 mapping sequence shows a mass with high relaxation time (107 ms). LV, left ventricle; LA, left atrial.

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  Figure 4. Multimodal image. (A) 2D TEE. Short axis, pulmonary valve focus. Ovoid mass of 14 mm arising from the pulmonary valve cusp (white arrow). (B) TEE, Volume rendering, transillumination. Short axis, pulmonary valve focus. Pedunculated ovoid mass with a multi-lobed appearance (dashed circle). (C) TEE, Multi-planar reconstruction. Short axis, pulmonary valve focus. More precise dimensions (maximum diameter 15 mm) and implantation location (left semilunar cusp). (D) Sagittal reformat CT. Mobile rounded mass with a multi-lobed surface arising from the pulmonary valve (black arrow). It is connected via a thin stalk to the pulmonary cusp. (E) Double oblique cardiac CT. A hypotenuated mass dependent on the left posterior sinus (black arrow). (F) 3D volume rendered CT. A photorealistic image of papillary fibroelastoma, a rounded mass prolapsed into the right ventricular outflow tract (white arrow). RVOT, right ventricular outflow tract; PA, pulmonary artery.