Percutaneous Mechanical Aspiration Revealing Lambl's Excrescences Initially Suspected as Papillary Fibroelastomas

Mobile valvular echodensities such as papillary fibroelastomas (PFEs) and Lambl's excrescences can appear similar on imaging yet differ markedly in management. PFEs are typically resected to prevent embolic events, whereas Lambl's excrescences are benign and not treated surgically. We report 2 high-surgical risk patients with mobile aortic valve lesions presumed to be PFEs who underwent percutaneous mechanical aspiration. Both procedures achieved safe lesion debulking without complication, and histopathologic analysis revealed Lambl's excrescences rather than PFEs. These first-in-human cases demonstrate that percutaneous mechanical aspiration can serve both diagnostic and therapeutic purposes, providing definitive tissue characterization and potentially sparing patients unnecessary surgery.