Cardiac fibromas are benign connective tissue tumors derived fromfibroblaststhat occur predominantlyin children andconstitutethesec-ond most common type (after the rhabdomyoma) of primary cardiactumoroccurringinthepediatricagegroup[1].Mostaredetectedinchil-dren younger than 10 years, and about one-third are diagnosed in in-fants younger than 1 year. Males and females appear to be equallyaffected. Cardiac fibromas are typically large tumors ranging from 3 to10cmin diameter.They usuallyoccurwithintheventricularmyocardi-um and much more frequently within the anterior free wall of the leftventricular wall or the inter-ventricular septum than in the posteriorleft ventricular wall or right ventricle [2]. Approximately 70% of fibro-mas are symptomatic, causing mechanical interference with intra-cardiac flow (usually with bulky intra-cavitary left ventricular or rightventricular tumors), ventricular systolic function (usually with largeintra-myocardial left ventricular tumors), or conduction disturbances(usually with tumors arising in the inter-ventricular septum). Themost common clinical manifestations are congestive heart failure(21%), ventricular tachy-arrhythmias (13%) and atypical chest pain(3.5%)[3].Suddencardiacdeathoccursin14%ofpatientswithfibromas,typically in infants. Cardiac fibromas do not show spontaneous regres-sion and surgical resection generally remains the treatment of choicefor these tumors in children.A 51-year old man (C.R.) was referred to the emergency room fortypical dizziness, sweating and vomit. Electrocardiogram showedsinus rhythm with Q wave in D1, D2, aVL and from V4 to V6 with Twave inversion from V4 to V6. Blood pressure at admission was150/100mmHg,troponin-Ivalueswerenormal.Thepatientwasthere-fore admitted to the acute cardiac care unit with a diagnosis ofsuspected acute coronary syndrome. Echocardiography showed, in offaxis views, a heterogeneous oval mass of the left ventricular lateralwall (5 × 3 cm) without involvement of mitral valve apparatus(Fig. 1a–b). Coronary angiography was normal.Cardiacmagneticresonanceimaging(cMRI),performedwitha1.5-Tmagnet(PhilipsAchieva)andacardiacphased-arraymulti-coil,showedin the mid-apical left ventricular lateral wall and inferior-lateral wallsegments a nodular intra-myocardial formation (5.3 × 3.6 cm) iso-intense in the sequences T1-TSE (turbo spin echo Fig. 2 left) and inCINE-TFE sequences (turbo field echo Fig. 2 right; Videos 1–3), hypo-intense in the sequences T2-SPIRR BB (black-blood — T2-short-tau-in-version recovery Fig. 3a–b; Video 4). In the sequences for the dynamicstudy of first pass a minimal and inhomogeneous enhancement aftergadolinium was evident (Fig. 4 left; Video 5). In late enhancementPSIR-TFE (phase sensitive inversion recovery turbo field echo) se-quences, the nodular formation was hyper-intense (Fig. 5; Video 6).A diagnosis of cardiac fibroma was therefore based on such cMRIfindings (iso-intense mass in cine“bright blood” balanced fast field-echo images and in T1, hypo-intense in T2-STIR, minimal enhance-ment with gadolinium at the dynamicfirst pass and hyper-intensein PSIR sequences). The patient did not undergo endo-myocardialbiopsy and surgical excision because of the large dimension of themass.Thecardiac fibromaisararebenigntumoroftheheart.Thefirsttoolto assess such lesion is echocardiography, which can provide informa-tion on the tumor's extent and on ventricular and valvular function.cMRImayimproveandhelpthediagnosisbythetissuecharacterizationof the lesion. cMRI allows the identification of cardiac and para-cardiacsuspicious masses; a precise definition of the extension and the rela-tionships as well as possible involvement of vascular and mediastinalstructures, the infiltration of the pericardium and relationships withnormal intra-cardiac structures may be obtained. Finally, the signalcharacteristics and contrast are useful for tissue characterization of