Papillary fibroelastoma of the mitral valve chordae with systemic embolization

Papillary fibroelastoma (PFE) is a rare benign tumor that most commonly involves heart valves. Cardiac PFE involving the mitral chorda is rarer. Most papillary PFE are asymptomatic; rarely, they are diagnosed because of cardiac symptoms or after an embolic event. In this case, a 70-year-old woman presented with an acute cerebral ischemic infarct. Evaluation for potential embolic source revealed a mass on the mitral chordae. The findings of cardiac magnetic resonance (CMR) tissue characterization of the mass corroborated the diagnosis of mitral valve tumor. She underwent surgical resection of this mass and histology, which confirmed a PFE. <Learning objective: PFE are easily detected on echocardiography but are difficult to visualize with CMR. Their small size and rapid, extensive movement render adequate CMR imaging extremely difficult. This case highlights the ability of CMR to characterize the tissue characteristics and enhancement pattern which enables non-invasive assessment for the etiology of intra-cardiac masses and usually distinguishes a tumor from thrombus.>.