LAUSR

We report a 71-year-old female patient with an atypical location of a papillary fibroelastoma (PFE). She has a history of stroke without sequelae 18 months before admission and was derived to our Hospital for tumor resection. Based on brain CT scan findings, we confirmed a diagnosis of cerebral infarction. TEE showed a mobile mass, ovoid, 20 × 14 mm, in the left atrium, adhered to the ligament of Marshall, with an irregular surface compatible with a PFE (Fig. 1a and Movie 1). In our previous study, PFEs [1] were located in heart valves in 70.54% of cases and in 29.6%, they were located in the endocardium of the heart. In our patient, PFE were located in the ligament of Marshall, which to our knowledge has never been reported previously in the echocardiographic literature. Intraoperative findings confirmed the atypical location of this atrial mass and the tumor resection was performed without intraoperative complications. The gross and histopathologic evaluation confirmed the diagnosis of PFE (Fig. 1b–e). Mediastinitis was diagnosed by culture-directed 9 days after cardiac surgery. After antibiotic therapy, early wound exploration, and debridement followed by sternal reconstruction, the patient was discharged 40 days after surgery and transthoracic echocardiogram showed no remnants of the mass in the left atrium. This case report confirms the fundamental role of echocardiography for the evaluation of intracardiac masses, as it supplies adequate information about size and attachment. The PFE is the most common benign primary cardiac