Left Atrial Papillary Fibroelastoma and Mediastinal Radiotherapy

High-dose mediastinal radiotherapy can result in progressive valvular degeneration and secondary malignancy.

A 50-year-old woman with prior chest radiotherapy and stem cell transplantation for Hodgkin lymphoma presented with progressive exertional dyspnea. Transthoracic and transesophageal echocardiography revealed severe mitral regurgitation with mitral annular calcification and an incidental finding of a mobile 12 × 8 mm left atrial mass. The patient subsequently underwent mitral valve replacement and resection of the left atrial mass with histologic confirmation of a degenerative, fibrotic mitral valve and a papillary fibroelastoma (PFE).

Secondary malignancy can arise after radiotherapy treatment among cancer survivors. This would have led to radiation fibrosis of the mitral valve and potential development of a PFE. Although PFEs are histologically benign and exceedingly rare, their embolic potential warrants surgical intervention.

Cardiac complications from mediastinal radiotherapy can manifest decades later as valvular degeneration and, occasionally, rare tumors such as PFE.