A 48 year old man with a history of rectocolitis was admitted to a coronary care unit because of an inferior myocardial infarction. Revascularisation was not performed because of the absence of pain at the time of admission and delay (six hours) after the onset of thoracic pain. The patient had no risk factors for atherosclerosis apart from smoking, which he had stopped two years ago.

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 Transthoracic cross sectional echocardiography revealed an abnormal structure behind the right coronary aortic cusp. This was confirmed by multiplane transoesophageal echocardiography, which showed a pedunculated tumour overhanging the right coronary ostium. Because of the risk of embolisation, coronary angiography was not performed and surgical removal of the tumour was attempted. At surgery, behind the right coronary cusp, only remnants of the tumour were found and excised. Peroperative videoscopy detected the tumour trapped in the right coronary ostium. The tumour (7 mm diameter) was extracted with a Fogarty catheter. Histopathology showed a fibroma with areas of attached thrombus. One month after surgery, coronary angiography was performed, which showed single vessel disease with a 70% distal stenosis of the right coronary artery. Because of inferior akinesia of the left ventricle and negative stress test, coronary revascularisation was not attempted.