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(Circulation. 2001;104:e87.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Papillary Fibroelastoma of the Left Atrial Free Wall

Thomas Wolber, MD; Marco Facchini, MD; Sandra Huerlimann, MD; Hans Rickli, MD

From the Department of Cardiology, Kantonsspital St Gallen (T.W., M.F., H.R.), St Gallen, and the Department of Pathology, University Hospital Zürich (S.H.), Zürich, Switzerland.

Correspondence to Dr Thomas Wolber, Kardiologie, Kantonsspital St Gallen, Rorschacherstrasse, CH 9007 St Gallen, Switzerland. E-mail thomas{at}wolber.at

A 63-year-old woman was referred for echocardiography in search of a potential cardiac source of systemic embolism. She had experienced 2 transient ischemic attacks during the previous 2 years. Transthoracic echocardiography (Figure 1) revealed a 2.5x2-cm mass attached to the left atrial lateral wall. Transesophageal examination (Figure 2) showed a 27x25x22-mm mobile, spherical tumor with 1- to 5-mm mobile projections. A peduncular attachment to the left atrial wall was demonstrated between the left atrial appendage and the left upper pulmonary vein. Additionally, there was mild mitral regurgita-tion due to a partial flail leaflet caused by a chordal rupture. Laboratory testing for serum interleukin-6 was negative.

View larger version (97K): [in this window] [in a new window]   Figure 1. Transthoracic apical 4-chamber view. Arrows indicate mass attached to the left atrial lateral wall (see Movie I, available in the online only Data Supplement at http://www.circulationaha.org).

View larger version (109K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiogram showing a mobile mass attached to the left atrial free wall (see Movies II and III at http://www.circulationaha.org).

The tumor was removed surgically, and the mitral valve was repaired. Histological examination (Figure 3) showed multiple branching papillary fronds consisting of dense fibroelastic tissue surrounded by a layer of loose connective tissue with mucopolysaccharides. The fronds were covered by endocardial cells. The patient recovered without any complications and remained free of neurological symptoms for the entire 12-month follow-up period.

View larger version (122K): [in this window] [in a new window]   Figure 3. Histological specimen. A, Multiple papillary fronds (hematoxylin-eosin; magnification x10). B (inset), Central core of dense fibroelastic tissue (arrowhead) and loose connective tissue with mucopolysaccharides (arrows) (elastic van Gieson; magnification x50).

Footnotes

Movies I, II, and III, showing the transthoracic and transesophageal echocardiograms, are available in an online only Data Supplement at http://www.circulationaha.org

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editoral Office, St.Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wolber, T. Articles by Rickli, H. Search for Related Content PubMed PubMed Citation Articles by Wolber, T. Articles by Rickli, H. Related Collections Echocardiography Embolic stroke