Papillary Fibroelastoma Found With Transesophageal Echocardiography After a Normal Transthoracic Echocardiography

• Published in: Seminars in cardiothoracic and vascular anesthesia Vol. 21; no. 3; p. 217
• Main Authors: Cook, Andrew G, Viswanath, Omar, D'Mello, Jayanand
• Format: Journal Article
• Language: English
• Published: United States 01.09.2017
• Subjects: Echocardiography - methods; Echocardiography, Transesophageal - methods; Fibroma - complications; Fibroma - diagnostic imaging; Heart Atria - diagnostic imaging; Heart Atria - pathology; Heart Neoplasms - complications; Heart Neoplasms - diagnostic imaging; Heart Neoplasms - pathology; Humans; Ischemic Attack, Transient - etiology; Male; Middle Aged; transesophageal echocardiogram; transthoracic echocardiogram; cardiac tumors; papillary fibroelastoma; coumadin ridge
• ISSN: 1940-5596
• DOI: 10.1177/1089253217699281

We present the case of a patient with transient ischemic attacks who was being investigated for multiple embolic strokes. Initial workup, including brain computed tomography, computed tomography angiography, and transthoracic echocardiography (TTE) were negative for a source until transesophageal echocardiography (TEE) found a mass in the left atrium. The TEE differentiated the mass as a rare cardiac papillary fibroelastoma on the left atrial free wall confirmed by postsurgical pathology. This case highlights the importance of TEE as a diagnostic tool for its ability to more accurately differentiate and characterize the tumor compared with TTE. This case underscores that a negative TTE does not equate to zero risk of the presence of a cardiac tumor. It is prudent for the clinician to be cognizant that it may be beneficial to perform a TEE even with a negative TTE workup.