Diagnosis of Cardiac Papillary Fibroelastoma Presenting with Acute Coronary Syndrome and Concomitant Salmonella Bacteraemia, Mimicking Aortic Endocarditis.

Introduction: A case of fibroelastoma of the aortic valve in a patient with acute coronary syndrome has been reported. Cardiac papillary fibroelastomas (PFE) are rare cardiac tumours that are generally benign. In most cases they are incidental findings, their first clinical manifestation is often associated with embolic events.

Case Presentation: We present the case of a 63-year-old man who experienced coronary embolization without any indications of underlying coronary artery disease. Further investigation led to the identification of the cause of embolization. The concomitant presence of Salmonella bacteraemia, associated with symptoms of gastrointestinal inflammation and elevated inflammation indices, led to the hypothesis of valvular endocarditis. Therefore, a transoesophageal echocardiogram was performed, which confirmed the presence of a mobile, well-demarcated, echo-dense mass identified on the left coronary cusp. Despite the diagnostic uncertainty between fibroelastoma and endocarditic formation, the occurrence of the embolic event and the marked hypermobility we decided that prompt intervention was required. Surgical cleavage of the valve formation was performed, revealing macroscopic morphological characteristics consistent with, PFE which was confirmed by the histological finding.

Conclusions: This case highlight the importance of a comprehensive diagnostic approach, including transoesophageal echocardiography, in patients with embolic events with no obvious evidence of an embolic causes.

Learning Points: Cardiac papillary fibroelastomas (PFE) are rare cardiac tumours that are generally benign.Their first clinical manifestation is often associated with embolic events, also leading to acute coronary syndrome.In patients with embolic events with no obvious evidence of embolic causes, transoesophageal echocardiogram should be performed to look for PFE.