Papillary Fibroelastoma and Cerebrovascular Disease: Rare Stroke Cause and Multimodality Imaging Importance

Papillary fibroelastoma (PFE) is a rare benign cardiac tumor that may lead to embolic complications, particularly in patients with prosthetic valves.

A 62-year-old woman presented with dizziness, nausea, and left ocular paralysis. She had a history of hypertension, dyslipidemia, and mitral valve replacement. Electrocardiogram showed atrial fibrillation; transthoracic and transesophageal echocardiography revealed a mobile, pedunculated left ventricular mass (1.4 × 1.0 cm). Magnetic resonance imaging showed old cerebral infarcts. She underwent thoracotomy with mass resection and mitral/tricuspid valve replacement. Postoperatively, she developed nosocomial pneumonia, treated successfully with cephalosporins. She was discharged 16 days later. Histopathology confirmed PFE.

This case illustrates the diagnostic challenge of PFE, particularly when manifesting with neurologic symptoms. Multimodal imaging was crucial for diagnosis and surgical planning. PFE should be considered in patients with systemic embolism and cardiac masses, especially with prosthetic valves.

PFE, though benign, may cause severe embolic events and should be considered in patients with prior cardiac surgery and unexplained ischemia. Early echocardiographic detection and timely surgery are essential to prevent life-threatening complications.