DK2985_C000 1..28 - AlSharqia Echo Club

506 Transesophageal Echocardiography(A)(B)RVLVFigure 23.13 Transgastric mid-papillary view of a left ventricular cardiac fibroma (LV, left ventricle; RV, right ventricle). [Withpermission from Churchill Livingstone Inc. (13).]echocardiographic diagnosis of a lipoma remains difficultas it can mimic myxomas, fibromas, papillary fibroelastomas,and thrombi. Magnetic resonance imaging (MRI)may help confirm the fatty nature of the tumor (11,12).5. Papillary Fibroelastomas andLambl’s ExcrescencesPapillary fibroelastomas or papillomas are benign tumorsthat are clinically important because of their potential forsystemic embolization. They represent a small fractionof all primary cardiac tumors but are the most commontype of primary valve tumor. They can still be found anywherein the heart (Figs. 23.14 and 23.15) and have beendescribed in atypical locations such as the LAA (14).They can occur in any age group although they are mostcommon in patients .60 years of age, usually affectingthe aortic valve (AoV). Fibroelastomas tend to arise inareas of endocardial damage such as the sites of valvularsclerosis, rheumatic heart disease, or cardiac surgery.(A)(B)LAAoLVRVLVOTFIBROELASTOMA(C)LVOT FIBROELASTOMAFigure 23.14 (A, B) A 72-year-old man scheduled for coronary revascularization was found to have a mobile mass attached to the leftventricular outflow tract (LVOT). (C) Intraoperative findings. The pathological diagnosis was a papillary fibroelastoma (Ao, aorta;LA, left atrium; LV, left ventricle; RV, right ventricle). (Photo C courtesy of Dr. Pierre Pagé.)