Accidentally Discovered Aortic Valve Papillary Fibroelastoma in a Patient Presenting With Inferior Myocardial Infarction.

Papillary fibroelastomas (PFEs) are rare, benign primary cardiac tumors. Their clinical manifestations range from asymptomatic findings to serious embolic events, including cerebrovascular accidents, myocardial infarctions, or arrhythmias. Though extremely rare, PFEs have been associated with acute coronary syndrome in only a few cases documented in medical literature. We present the case of a 39-year-old male who presented with acute-onset severe chest pain and was diagnosed with inferior myocardial infarction. Coronary angiography revealed a high thrombus burden in the right coronary artery. Multimodality imaging, including transthoracic echocardiography and cardiac magnetic resonance imaging, identified a well-defined, mobile mass attached to the right coronary cusp of the aortic valve, highly suggestive of a PFE. Following a multidisciplinary consultation, we performed surgical excision of the mass, and histopathology confirmed the diagnosis of PFE. The patient made an uneventful recovery postoperatively. This case highlights the rare association of a PFE with acute coronary syndrome, emphasizing the importance of multimodality imaging in the accurate diagnosis of cardiac masses. Given the potential for serious embolic complications, prompt surgical intervention remains the treatment of choice in symptomatic cases. Further studies are needed to establish clear guidelines for the management of asymptomatic fibroelastomas.