Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of a cardiac mass incidentally identified on echocardiography. Clinical history is significant for [asymptomatic presentation / embolic event / syncope / palpitations]. No history of prior cardiac surgery or valvular disease. Mass characteristics on imaging are consistent with papillary fibroelastoma (PFE), appearing as a small, pedunculated, mobile lesion attached to the [valvular endocardium / chordae tendineae].
Clinical Examination Findings
Cardiovascular exam: Regular rate and rhythm. S1 and S2 heart sounds are normal. No audible murmurs, rubs, or gallops. Peripheral pulses are symmetric and full. No clinical signs of peripheral embolization (e.g., splinter hemorrhages, Janeway lesions, or Osler nodes). Neurological exam is non-focal.
Treatment Protocol
Management plan: Surgical excision is recommended given the risk of systemic embolization, particularly if the PFE is mobile or left-sided. Pre-operative transesophageal echocardiography (TEE) to confirm attachment site and exclude additional lesions. Post-operative management includes monitoring for rhythm disturbances and long-term surveillance with serial echocardiography.