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Lambl's Excrescence — EECC MCQ

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ModerateValvular Heart DiseaseLambl's ExcrescenceEECC

A 55-year-old man has TOE showing a mobile, thin, filamentous structure on the aortic valve. It measures 3 mm, is attached to the closing edge of the non-coronary cusp, and has a characteristic strand-like appearance. No vegetations or valve dysfunction are present. What is the most likely diagnosis?

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Correct answer: D — Lambl's excrescence — a degenerative valvular strand that is usually incidental and benign, though large or mobile excrescences may rarely be associated with embolic events

Lambl's excrescences are thin, filamentous strands (typically 1-5 mm) attached to valve closure lines, representing degenerative fibroelastic tissue. They are found in 70-80% of adults at autopsy and are usually incidental findings on TOE. Lambl's excrescences are distinguished from: (1) vegetations (which are irregular, heterogeneous, attached to the upstream surface, and associated with valvular destruction); (2) papillary fibroelastomas (which are larger, round/pedunculated with a stippled appearance); (3) thrombi (which are typically echogenic and associated with structural abnormalities). While generally benign, case reports have linked larger Lambl's excrescences (>10 mm) to cryptogenic stroke. There is no consensus on treatment for incidental Lambl's excrescences; antiplatelet therapy may be considered if associated with embolic events.

Reference: EACVI/ASE Cardiac Masses Guidelines