Papillary Fibroelastoma of the Left Atrial Free Wall
A 63-year-old woman was referred for echocardiography in search of a potential cardiac source of systemic embolism. She had experienced 2 transient ischemic attacks during the previous 2 years. Transthoracic echocardiography (Figure 1) revealed a 2.5×2-cm mass attached to the left atrial lateral wall. Transesophageal examination (Figure 2) showed a 27×25×22-mm mobile, spherical tumor with 1- to 5-mm mobile projections. A peduncular attachment to the left atrial wall was demonstrated between the left atrial appendage and the left upper pulmonary vein. Additionally, there was mild mitral regurgita-tion due to a partial flail leaflet caused by a chordal rupture. Laboratory testing for serum interleukin-6 was negative.
The tumor was removed surgically, and the mitral valve was repaired. Histological examination (Figure 3) showed multiple branching papillary fronds consisting of dense fibroelastic tissue surrounded by a layer of loose connective tissue with mucopolysaccharides. The fronds were covered by endocardial cells. The patient recovered without any complications and remained free of neurological symptoms for the entire 12-month follow-up period.
Movies I, II, and III, showing the transthoracic and transesophageal echocardiograms, are available in an online only Data Supplement at http://www.circulationaha.org
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editoral Office, St.Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.