Int J Cardiovasc Imaging (2015) 31:315–317
DOI 10.1007/s10554-014-0552-3
IMAGES IN CV APPLICATIONS
Asymptomatic giant cardiac fibroma presenting as mitral valve
prolapse in an adult patient
Sunny Goel • On Chen • Igor Brichkov •
Jeffrey Lipton • Lekshmi Seemanthini •
Jacob Shani
Received: 22 September 2014 / Accepted: 29 September 2014 / Published online: 14 October 2014
Ó Springer Science+Business Media Dordrecht 2014
A 61 year old woman with a newly diagnosed heart mur-
mur underwent an echocardiogram showing an intramyo-
cardial mass and mitral valve prolapse (Panel A and Panel
B). A computed tomography (CT) scan of the chest
revealed a round mass in the left chest contiguous with the
myocardium of the left lateral wall and no significant mass
effect on the cardiac chambers (Panel C). Cardiac magnetic
resonance (CMR) revealed a myocardial mass measuring
6 9 5 9 8 cm with well-defined borders beginning at the
level of the left atrium, involving the posterior leaflet of the
mitral valve and extending to the basal and mid lateral and
inferior walls of the left ventricle (Panel D and Panel E).
There was no signal enhancement on T2 weighted images
(Panel F) and no fat seen on fat saturation sequences (Panel
G). The mass appeared to enhance similar to the normal
myocardium on first pass perfusion imaging and exhibited
marked homogenous delayed Gadolinium enhancement on
inversion recovery sequences (Panel H and Panel I). The
patient initially underwent an endomyocardial biopsy via
right femoral artery under trans-esophageal echocardio-
gram (TEE) guidance which was unsuccessful, and was
later converted to an open thoracoscopic myocardial
S. Goel (&)
O. Chen
I. Brichkov
J. Lipton

L. Seemanthini
J. Shani
Maimonides Medical Center, 4802, Tenth avenue, Brooklyn,
NY 11219, USA
e-mail: maverickmedico1985@gmail.com
biopsy. (Panel J). Histological analysis of the biopsied
sample revealed bland spindle cells and cardiac myoctes at
edge, confirming the diagnosis as cardiac fibroma (Panel
K and Panel L) (Fig 1).
Cardiac fibromas are rare, benign, intramyocardial
tumors that make up 15 % of benign cardiac tumors in
children and 3 % of all benign cardiac tumors in adults,
with a mean age at presentation of 13 years [1]. Most
fibromas originate in the left ventricular free wall or
intraventricular septum with symptoms and clinical pre-
sentation varying according to the size and the location
of the tumor. Common presentations include chest dis-
comfort, syncope, heart failure, cyanosis, arrhythmias or
even sudden death but approximately one-third of the
patients are asymptomatic and are discovered inciden-
tally on imaging studies [2]. The management of
asymptomatic patients, such as our patient is challenging;
clinicians have to weigh the risk of surgical resection of
the tumor to the benefit of conservative management. In
our patient conservative management was elected with
close follow-up and referral for evaluation for a heart
transplant.
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Fig. 1 a, b These are echocardiogram images showing prolapsing
anterior mitral valve leaflet (blue arrow in Panel A) and color Doppler
showing mild mitral regurgitation (Panel B). c CT scan image
revealing a round mass (white asterisk) in the myocardium of the left
lateral wall with homogenous attenuation. d, e These are Cardiac MRI
long axis (Panel D) and short axis (Panel E) steady-state free
precession sequences showing the mass (white asterisk) extending
from the level of the left atrium and extending into the basal and mid
lateral walls of the LV. f, g No edema or fat content is seen on these
CMR images. Shown are the long axis two chamber views with T2
weighted dark blood sequences, without fat saturation (Panel F) and
with fat saturation (Panel G). No T2 signal enhancement as compared
to normal myocardium and no fat content seen in the mass (white
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Int J Cardiovasc Imaging (2015) 31:315–317
asterisk) on fat saturation sequences. h, i These are Cardiac MRI long
axis (Panel H) and short axis (Panel I) views showing an intense
homogenous delayed gadolinium enhancement on inversion recovery
sequences (black asterisk). j This is an intraoperative image obtained
during thoracoscopic myocardial biopsy showing the resected parietal
pericardium (arrow) and the myocardial mass (asterisk) bulging
through the left ventricular wall. k, l Panel K. This is a 9100
Hematoxylin and eosin (H & E) pathological slide of the biopsied
tissue sample showing the fibrous tissue at the bottom and the normal
myoctes (marked by asterisk) at the top. Panel L. 9200 Hematoxylin
and eosin (H & E) pathological slide of the biopsied tissue sample
showing the bland spindle cells (shown by black arrow) interspersed
along the collagen fibres
Int J Cardiovasc Imaging (2015) 31:315–317 317

Conflict of interest None. 2. Nwachukwu H, Li A, Nair V, Nguyen E, David TE, Butany J

(2011) Cardiac fibroma in adults. Cardiovasc Pathol 20(4):
e146–e152
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(1994) Cardiac fibroma: clinicopathologic correlates and surgical
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