Papillary fibroelastoma of the pulmonary valve

A 42-year-old man with a history of hypertension, type 2 diabetes mellitus and obesity was referred to our center due to the incidental finding of a mass adjacent to the pulmonary valve on a routine transthoracic echocardiogram (Figure 1). He was asymptomatic and physical examination and laboratory values were unremarkable. The transesophageal echocardiogram (Figure 2) revealed a pedunculated, highly mobile hyperechogenic mass, measuring 8 mm × 7 mm, attached to the right pulmonary valve leaflet. The pulmonary valve was functionally normal, with no observed pulmonary regurgitation or stenosis, and no masses were visualized on any other valves or heart chambers. Computed tomography angiography excluded significant coronary stenosis and confirmed the presence of a mass at the level of the pulmonary valve (Figure 3). We concluded that it most likely represented a papillary fibroelastoma. Surgical excision of the mass was decided upon due to its mobility and location, resulting in high risk for embolization. It was successfully resected, with preservation of the valve apparatus. Histopathological examination confirmed the diagnosis of papillary fibroelastoma (Figure 4). Papillary fibroelastomas are rare benign tumors of the endocardium that account for around 7% of all heart tumors.