Cardiac Papillary Fibroelastoma Mimicking Infective Endocarditis in an Octogenarian: A Case Report

SIYAM Hamady — 2025-09-12

Introduction: Papillary fibroelastoma is a rare benign cardiac tumor, usually discovered incidentally or during evaluation for embolic events. Its echocardiographic appearance often mimics infective endocarditis, making diagnosis challenging.

Case Presentation: We report the case of an 83-year-old man with a history of hypertension and hypercholesterolemia, presenting with progressive dyspnea, orthopnea, and angina. Initial evaluation revealed elevated biomarkers and pulmonary edema. Transthoracic and transesophageal echocardiography showed a mobile mass attached to the posterior mitral leaflet, raising suspicion of infective endocarditis. However, blood cultures remained negative, and PET scan was inconclusive. The patient underwent surgical excision, and histopathological examination confirmed a papillary fibroelastoma. Postoperative evolution was favorable.

Conclusion: Papillary fibroelastoma should be considered in the differential diagnosis of valvular masses. Multimodal imaging is crucial, but histology remains the gold standard. Early surgical excision is recommended in symptomatic patients, even in advanced age, to prevent embolic complications.

Cryptogenic Stroke with Isolated Cranial Nerve Deficits Attributable to a Small PFO: Successful Management with Cocoon Occluder

Kalyan Munde — 2025-09-17

Patent foramen ovale (PFO) is present in approximately 20–25% of the general population but is implicated in only a small subset of ischemic strokes, particularly in young adults with cryptogenic events. Stroke in individuals under 45 years accounts for only 10–15% of all ischemic strokes, and PFO-related presentations with isolated cranial nerve involvement are exceptionally rare.

We report a 40-year-old male who presented with acute slurring of speech and deviation of the mouth to the left. Neurological examination revealed dysarthria and tongue deviation without motor weakness. A thorough work-up for young-onset stroke was performed: bilateral carotid and vertebral Doppler were normal, chest radiograph was normal, antinuclear antibody (ANA) and antiphospholipid antibody (APLA) profiles were negative, homocysteine was borderline elevated, and fundus examination showed no papilledema. CT venous angiography of the lower limbs ruled out deep venous thrombosis. Magnetic resonance imaging demonstrated acute non-hemorrhagic infarcts in the right inferior frontal gyrus and right post-central gyrus. Transthoracic echocardiography with bubble contrast revealed right-to-left shunting during Valsalva, and transesophageal echocardiography (TEE) confirmed a 4-mm PFO.

Given the patient’s young age and isolated cranial nerve presentation, TEE-guided PFO closure was performed with a Cocoon 30/30 occluder device under fluoroscopic guidance, with no residual shunt post-procedure. The patient remained hemodynamically stable, developed no arrhythmia, and demonstrated marked improvement in speech function during follow-up.

This case underscores the clinical relevance of small but hemodynamically significant PFOs in young patients with cryptogenic stroke and highlights the importance of systematic etiological evaluation and timely intervention.

Cardiology and Angiology: An International Journal

Cardiac Papillary Fibroelastoma Mimicking Infective Endocarditis in an Octogenarian: A Case Report

Cryptogenic Stroke with Isolated Cranial Nerve Deficits Attributable to a Small PFO: Successful Management with Cocoon Occluder