A Giant in Plain Sight: Multimodality Imaging of a Left Ventricular Fibroma

A 14-year-old survivor of out-of-hospital ventricular fibrillation arrest with a large intramural left ventricular fibroma and a secondary-prevention implantable cardioverter-defibrillator underwent multimodality reassessment after device lead fracture. Left ventricular ejection fraction was mildly reduced, whereas speckle-tracking echocardiography demonstrated near-akinetic deformation within tumour-bearing segments. Cardiac computed tomography and three-dimensional reconstruction showed the left circumflex coronary artery and first obtuse marginal branch coursing directly over the mass, with additional proximity to the lateral mitral apparatus. These findings demonstrated substantial regional mechanical impairment while defining the hazards of complete resection. Following multidisciplinary review, device protection and imaging surveillance were favoured over high-risk surgery. This case illustrates how complementary functional and anatomical imaging can resolve a complex management dilemma in ventricular fibroma.