Cardiac Fibroelastoma versus Thrombus: Echocardiographic Evidence Can Be Misleading.

John P O’Laughlin,Iosif Gulkarov,Gautam Verma

doi:10.1155/2016/2896056

John P O’Laughlin, Iosif Gulkarov + Show 1 more

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https://doi.org/10.1155/2016/2896056

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Abstract

We present a case of a young female with stroke symptoms who underwent valve sparing resection of a presumed fibroelastoma based on echocardiographic findings. After confirming embolic stroke, she underwent excision of the lesion, which on pathology revealed a nonbacterial thrombus. Ultimately, this led to a more extensive work-up leading to the discovery of a papillary serous ovarian carcinoma, the underlying cause of her hypercoagulable state. The initial echocardiographic findings painted the clear picture of a papillary tumor on the aortic valve which was likely the source of the emboli resulting in ischemic stroke. This unique case presentation illustrates that imaging, including echocardiography, may not always coincide with the clinical diagnosis. Thus, understanding the differential diagnoses of cardiac masses is of vital clinical significance. The distinction of fibroelastoma versus the much less common finding of aortic thrombus may lead to early diagnosis of malignancy and prevention of life threatening events due to stroke or undiagnosed disease.

Highlights

The incidence of primary cardiac tumors is rare with the top three most common tumors consisting of myxomas, lipomas, and fibroelastomas [1,2,3]
We present a unique case of a presumed aortic valve fibroelastoma that after valve sparing excision turned out to be a nonbacterial thrombus
Cardiac tumors can be categorized into primary cardiac neoplasms or metastatic deposits from other remote primary neoplasms; most commonly breast, lung, lymphomas, melanomas, and renal tumors [6]

Summary

Introduction

The incidence of primary cardiac tumors is rare with the top three most common tumors consisting of myxomas, lipomas, and fibroelastomas (in order of respective occurrence) [1,2,3]. Fibroelastomas are described as having a papillary structure and may be found throughout the endocardial tissues, with an affinity for valvular structures [4] Clinical presentation of this tumor can vary with most patients presenting asymptomatic with incidental finding on echocardiography. Tumors on the right side of the heart are commonly asymptomatic or patients may present with pulmonary emboli [5], whereas left sided tumors can result in life threatening embolic phenomena [5] This is a result of the fragile nature of the tumor’s composition and their high affinity for platelet aggregation [5]. Transesophageal echocardiography revealed a large, papillary, solid, fixed mass, measuring 7 × 7 mm on the left coronary cusp (Figure 1) of the aortic valve that was suspected to be an aortic fibroelastoma due to its papillary structure and size She underwent valve sparing excision of the fibroelastoma (Figure 2). She went on to undergo bilateral salpingooophorectomy, omentectomy, lysis of adhesions, and peritoneal biopsies confirming a final diagnosis of papillary serous ovarian carcinoma, Stage IIc

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Conclusion