• Images in cardiology

A 41 year old previously healthy woman presented with left sided motor deficit. Nuclear magnetic resonance imaging of the brain showed a recent ischaemic lesion of the right thalamus. Transthoracic echocardiography was normal. A transoesophageal echocardiogram revealed a round, mobile, pedunculated, 5 mm mass attached to the commissure of the non-coronary cusp of the aortic valve (figures).The patient underwent uneventful surgery for ablation of the mass, with preservation of the aortic valve. Histologic examination diagnosed papillary fibroelastoma.

These are rare primary cardiac neoplasms, that are most often attached to valves, especially the aortic valve (followed in frequency by the mitral valve). They are usually single, small in size (< 20 mm in diameter) and may be either pedunculated or sessile. Embolic events with this tumour have been reported, although the incidence of this complication has not been well defined.

This case shows the importance of performing transoesophageal echocardiography in young patients presenting with unexplained stroke, which may identify an embolic origin amenable to treatment.