1. Case 5: 55yr / M Lung cancer, 3 years ago
Chest CT
PET Axial
Presented by Ju Won Lee, Yeon Hyeon Choe.
Sungkyunkwan Univ. Samsung Medical Center (SMC), Seoul, Korea

2. Nongated Chest CT Chest CT
Incidentally noted AV mass

3. Transesophageal Echo Echocardiography
AV mass

4. Cardiac CT

5. Heart in Heart?
Cardiac CT

6. Cardiac MRI
Double IR
T1W Double IR
T2W Triple IR

7. Cardiac MRI
Perfusion
CE-T1WI, double IR
DEMR

8. What is your diagnosis? What is your impression? Vegetation Thrombus
Fibroelastoma
Intimal sarcoma

9. Surgical Findings

10. Pathological Findings
Photomicrograph
Pathological Findings

11. Papillary fibroelastoma
The 3rd most common primary benign cardiac neoplasm (myxoma > lipoma)
Common in cardiac valves (3/4 of all cardiac valvular tumors)
More in left side
Possibly on endocardium
RadioGraphics 2005

12. Papillary Fibroelastoma
Grinda J.-M. et al.; J Thorac Cardiovasc Surg 1999;117:
Copyright ©1999 The American Association for Thoracic Surgery

13. Papillary fibroelastoma
DDx: vegetation
Papillary fibroelastoma
Free from valvular leaflet destruction and valvular incompetence
Away from the free edge
Incidentally detected, no infective endocarditis symptoms
RadioGraphics 2005

14. Papillary Fibroelastoma
Usually undetectable by CT or MRI due to small size (< 1.5 cm Φ) and mobility
Transvalvular turbulence might be noted on cine MRI
Kim EY, Choe YH et al. Korean J Radiol 2009;10: