Echocardiographic Mitral Valve Fibroelastoma in a Patient With Hypertrophic Cardiomyopathy.

BACKGROUND

Papillary fibroelastoma (PFE) is a benign cardiac tumor typically found on valves and is often asymptomatic. However, embolic complications are known.

CASE SUMMARY: A patient with hypertrophic cardiomyopathy (HCM) was found to have an echocardiographic mass on the mitral valve. Despite no histologic confirmation, the imaging characteristics were consistent with PFE. The patient was managed conservatively and has remained asymptomatic under clinical and echocardiographic surveillance.

DISCUSSION: Although PFEs have been reported on the aortic valve and left ventricular outflow tract in HCM patients, mitral valve involvement is rare. This case challenges the theory that PFEs arise from hemodynamic trauma in high-flow regions. It also supports the individualized approach to managing incidental valvular masses and contributes to the evolving understanding of PFE pathogenesis.

TAKE-HOME MESSAGES: Hemodynamic flow may not fully explain PFE development in HCM. Individualized management is key for asymptomatic patients with incidental valvular mass suggestive of PFE.