Pulmonary Valve Papillary Fibroelastoma: A Rare Source of Pulmonary Embolism

Papillary fibroelastoma (PFE) is the second most common benign primary cardiac tumor, usually affecting left-sided valves. Pulmonary valve (PV) involvement is extremely rare, representing less than 8% of all PFEs. Although often asymptomatic, PFEs can present with embolic events. We report a 60-year-old man admitted with acute dyspnea, orthopnea, and lower-limb edema. Transthoracic echocardiography revealed severe left ventricular systolic dysfunction (ejection fraction: 15%), severe functional mitral regurgitation, and a mobile echogenic mass (1.0 × 0.8 cm) attached to the arterial surface of the PV consistent with a PFE. Chest computerized tomography (CT) confirmed bilateral segmental pulmonary emboli with infarctions and pulmonary artery dilation. Coronary angiography excluded ischemic disease. Given the patient's new-onset heart failure with reduced ejection fraction and high operative risk, the heart team opted for initial anticoagulation and optimized heart failure therapy, postponing surgical resection until stabilization. PV PFE is a rare but potentially fatal cause of pulmonary embolism. Multimodality imaging is crucial for diagnosis, and individualized treatment is required to balance embolic risk and surgical mortality.