Cardiac papillary fibroelastomas are rare, usuallybenign tumors that can be detected at autopsy, during open-heart surgery, or with echocardiography. They usually arise from the cardiac valves and more commonly are found on the left side of the heart. Embolization of left-sided and tricuspid valve tumors has been well documented. This is the 1st reported case of pulmonary embolization of a papillary fibroelastoma arising from the pulmonary valve.

Clinical diagnostics of papillary fibroelastoma.Klin Med (Mosk). 2007;85(12):7-11.

Papillary fibroelastoma (PFE) is a benign heart tumor, the diagnosis of which is difficult. Clinical manifestations of PFE are non-specific and scarce, and for this reason the tumor is often revealed during a heart surgery of an autopsy. PFE affects patients of all ages from neonates to 96-year-old ones and is often localized on valvular cusps, although vegetations may appear on other intracardiac structures. The histogenesis of the tumor is unclear; there are several theories of PFE origin (hemodynamic effects on the myocardium, viral theory, iatrogenic theory etc.) Macroscopically the tumor is small size, villous, whitish-grey, consists of a pedicle and villi of gely-like soft or dense-elastic consistence. The mobility of the tumor and the fragmentation of its tissue lead to its main complications such as obstruction of cardiac cameras (in-flow and out-flow disorders) and embolic syndrome in various basins (the brain, coronary arteries, the eye, the kidneys, and the lungs). The diagnosis of PFE is made using EchoCG, preferably transesophageal one. Treatment of PFE is surgical and consists of tumor or cusp removal. PFE should be differentiated from other benign and malignant heart tumors, infective endocarditis, heart echinococcosis, coronary artery disease, and cerebrovascular diseases.