SHM Converge Scientific Abstract ePoster Gallery-Fibroelastoma: A Rare but Important Differential to Consider in Cryptogenic Stroke

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A 56-year-old man was found unresponsive and initially suspected of having a cocaine overdose. In the emergency department, he was tachycardic, hypertensive, agitated, and urine toxicology was positive for cocaine. He developed severe metabolic complications including acute kidney injury, rhabdomyolysis, acute liver injury, hyperkalemia with ECG changes, and elevated troponin consistent with type 2 myocardial injury. He also developed pulmonary edema and hypoxemic respiratory failure requiring intubation, sedation, and CRRT.<br /><br />After stabilization and extubation, he was found to have new left arm weakness. MRI of the brain showed bilateral embolic infarcts, and MRI of the brachial plexus revealed acute plexopathy. Because of concern for a cardiac embolic source, transesophageal echocardiography was performed and identified a 0.96 x 0.74 cm sessile lesion on the aortic valve, consistent with a papillary fibroelastoma.<br /><br />Papillary fibroelastomas are rare benign cardiac tumors but carry a significant risk of embolization, including stroke and TIA. Small lesions may be missed on transthoracic echocardiography, making TEE important when suspicion remains high. Definitive treatment is surgical excision, ideally with valve preservation in appropriate surgical candidates. If surgery is delayed or not possible, long-term anticoagulation and close follow-up are recommended to reduce embolic risk.<br /><br />This case highlights the importance of considering papillary fibroelastoma in patients with unexplained embolic phenomena, even when presentation is initially dominated by another acute illness such as suspected overdose.

Asset Subtitle

Colin MacKay

Meta Tag

Author List Colin MacKay, Colin Martyn, James Pischke, Jesse Doyle

Category Clinical Vignettes

Concept Papillary Fibroelastoma

Concept Surgical Excision

Concept Embolic Event

Concept Transesophageal Echocardiography

Concept Stroke

Distinguished Non-Finalist

Presenter Organization Indiana University School of Medicine Internal Medicine Residency (Southwest)

Presenting Author Colin MacKay

Track Adult

Keywords

papillary fibroelastoma

aortic valve lesion

embolic infarcts

transesophageal echocardiography

cocaine overdose

rhabdomyolysis

acute kidney injury

pulmonary edema

brachial plexopathy

cardioembolic stroke

Papillary Fibroelastoma

Surgical Excision

Embolic Event

Transesophageal Echocardiography

Stroke