Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

• The papillary fibroelastoma is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves.
• When clinical conditions support the presence of infection, the papillary fibroelastoma may be misdiagnosed as a vegetation due to endocarditis.
• The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences.
• Careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.
• Immediate surgical removal and valve repair or replacement are the procedure of choice.

IntroductionThe papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves.Case presentationWe describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast’s surgery. A preoperative echocardiography demonstrated a mass >1 cm2 originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE.DiscussionWith the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences.ConclusionTo summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.