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Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events

Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small high...

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Autores principales: Mashicharan, Mary, El-Dean, Zein, Zlocha, Viktor, Khoo, Jeffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689122/
https://www.ncbi.nlm.nih.gov/pubmed/31413862
http://dx.doi.org/10.1530/ERP-19-0012
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author Mashicharan, Mary
El-Dean, Zein
Zlocha, Viktor
Khoo, Jeffrey
author_facet Mashicharan, Mary
El-Dean, Zein
Zlocha, Viktor
Khoo, Jeffrey
author_sort Mashicharan, Mary
collection PubMed
description Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source. LEARNING POINTS: Fibroelastomas are most commonly found on left-sided heart valves (aortic > mitral) and have the potential to cause systemic emboli associated with significant morbidity and mortality. A left atrial appendage (LAA) mass in a patient presenting with cerebrovascular events does not always represent thrombus. Uncommon aetiologies such as a cardiac tumour should be considered in the differential diagnosis. Transthoracic echocardiography (TTE) does not provide an accurate assessment of the LAA and should not be used to detect pathology within this structure. Transoesophageal echocardiography (TOE) is superior to TTE in imaging the LAA and provides a complete delineation of its anatomy. In addition, TOE can detect very small highly mobile lesions (as described in this case), which may be missed on other imaging modalities.
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spelling pubmed-66891222019-08-14 Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events Mashicharan, Mary El-Dean, Zein Zlocha, Viktor Khoo, Jeffrey Echo Res Pract Case Report Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source. LEARNING POINTS: Fibroelastomas are most commonly found on left-sided heart valves (aortic > mitral) and have the potential to cause systemic emboli associated with significant morbidity and mortality. A left atrial appendage (LAA) mass in a patient presenting with cerebrovascular events does not always represent thrombus. Uncommon aetiologies such as a cardiac tumour should be considered in the differential diagnosis. Transthoracic echocardiography (TTE) does not provide an accurate assessment of the LAA and should not be used to detect pathology within this structure. Transoesophageal echocardiography (TOE) is superior to TTE in imaging the LAA and provides a complete delineation of its anatomy. In addition, TOE can detect very small highly mobile lesions (as described in this case), which may be missed on other imaging modalities. Bioscientifica Ltd 2019-07-18 /pmc/articles/PMC6689122/ /pubmed/31413862 http://dx.doi.org/10.1530/ERP-19-0012 Text en © 2019 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Case Report
Mashicharan, Mary
El-Dean, Zein
Zlocha, Viktor
Khoo, Jeffrey
Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
title Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
title_full Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
title_fullStr Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
title_full_unstemmed Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
title_short Fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
title_sort fibroelastoma in an unusual location: a rare cause of multiple cerebrovascular events
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689122/
https://www.ncbi.nlm.nih.gov/pubmed/31413862
http://dx.doi.org/10.1530/ERP-19-0012
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