J Cardiovasc Ultrasound.  2008 Sep;16(3):99-101. 10.4250/jcu.2008.16.3.99.

Papillary Fibroelastoma of Pulmonary Valve Mimicking Infective Endocarditis

• Yoon HJ
• Kim SH
• Cho SH
• Kim KH
• Ahn Y
• Jeong MH
• Cho JG
• Park JC
• Kang JC

• KMID: 1486588
• DOI: http://doi.org/10.4250/jcu.2008.16.3.99

Abstract

In this report, we describe a case of previous undiagnosed masses of the pulmonary valve mimicking infective endocarditis that were incidentally found during the work-up of a 62-year-old woman, who was presented with abdominal discomfort and dyspepsia. The pathologic findings were characteristics of a papillary fibroelastoma. Although benign, papillary fibroelastomas have the potential to cause lethal embolic events such as stroke, myocardial infarction, and pulmonary embolism are reported in some cases. Tumor identification and surgical excision are important to prevent such complications.

Keyword

Fibroelastoma; Pulmonary valve

MeSH Terms

Dyspepsia
Endocarditis
Female
Humans
Middle Aged
Myocardial Infarction
Pulmonary Embolism
Pulmonary Valve
Stroke

Figure

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  Fig. 1 Chest X-ray reveals marked cardiomegaly, especially right atrium, right ventricle with prominent pulmonary artery. Subsegmental atelectasis is noticed on left upper lung field.

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  Fig. 2 Transthoracic echocardiography shows markedly dilated right atrium, right ventricle, pulmonary artery and inferior vena cava. Pulmonary valve stenosis and regurgitation are revealed (mild to moderate). PA: pulmonary artery, PV: pulmonary valve leaflet, IVC: inferior vena cava, HV: hepatic vein.

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  Fig. 3 Transthoracic echocardiography at the level of the pulmonary valve leaflet shows a 1.2×0.9 cm sized echogenic mass arising from the right cusp of the pulmonary valve. Ao: aorta, PA: pulmonary artery, PV: pulmonary valve leaflet.

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  Fig. 4 Computer tomography shows dilated pulmonary artery and nodular mass on pulmonary valve. There is no filing defect suggesting pulmonary thrombiembolism.

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  Fig. 5 (A) Gross specimen shows multiple frondlike structures giving the appearance of a sea anemone. Histology of the lesion shows each frond core consists of a central fibroelastic stroma lined by flat endocardial cells. (B) Hematoxilin-eosin stain, original magnification, (C) type IV collagen stain, ×400, (D) masson-trichrom stain, original magnification.

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