Papillary Fibroelastoma — EECC MCQ

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ModerateGeneral CardiologyPapillary FibroelastomaEECC

A 58-year-old man undergoes transthoracic echocardiography which shows an echogenic, mobile, pedunculated mass on the aortic valve with a characteristic stippled appearance. The mass is 8 mm. He has had a recent TIA. What is the most likely diagnosis?

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Correct answer: E — Papillary fibroelastoma — the most common primary cardiac valve tumour; typically small, pedunculated, and mobile; associated with embolic events and often requires surgical excision when symptomatic or mobile

Papillary fibroelastoma (PFE) is the most common primary tumour of cardiac valves, typically occurring on the aortic (36%) or mitral valve (29%). It is characterised by: small size (usually <20 mm), pedunculated attachment with a stalk, high mobility, and a characteristic stippled/shimmer appearance on echo ('sea anemone'). PFE can be incidentally discovered or present with thromboembolic complications (stroke, TIA, MI from coronary embolism). The ESC and ACC recommend surgical excision for: (1) symptomatic PFE (embolic events), (2) mobile PFE (high embolic risk even if asymptomatic), and (3) PFE >10 mm. Valve-sparing excision (shaving the tumour from the valve surface) is usually possible. Asymptomatic, small, non-mobile PFE can be monitored with antiplatelet therapy.

Reference: ESC Textbook of Cardiovascular Medicine; EACVI Cardiac Masses Guidelines