Login Here · Help ·
Public User
2X
| Home->COTW AMA Category 1 Credit for Physicians Only. ASRT CME is not available. |
Go to the COTW Archive |
|
Case-of-the-Week Information
|
|
The TEE showed: TVAn 4.44 cm with mild TR Mild MR Mass of the Aortic Valve - Lambl's Excrescence versus Fibroelastoma The mass is on the ventricular side of the RCC. The differential diagnosis is: Fibroelastoma Lambl's Ecxrescences Vegetation Artifact Calcified Node of Arantii Fibroma Given the presentation, we felt that the tumor was a fibroelastoma (FBE) (also called a papillary fibroelastoma (PFE). Fibroelastoma are benign cardiac tumors, accounting for 10% of all cardiac tumors, can occur on either side of the valve. FBE have been found on all valves. The aortic valve (48%) is more common than the mitral valve (37%). Male preponderance (58%) and the mean age is 56 years old. FBE have been found as small as 2 mm and as large as 70 mm. Surgical excision occurred in 79% of cases. The origin of FBE is not known. FBE are not congenital, but, may have occurred in response to surgery, radiation, viral/inflammation, or is similar to a hamartoma. Some suthors believe FBE are neoplasms. Fibroelastomas have similar appearance on cytology as do Lambl's Ecxrescences. FBE are consist of papillary fronds of collagen and elasting covered by endothelial cells. FBE are firmly attached to the valve. Embolism is thought to be unusual because fragments of FBEs have only rarely been found in arteries. It is more likely that FBE are a nidus for thrombus where the thrombus embolize rather than the FBE. Because of these reasons FBE may be treated with anticoagulation in whom surgery is contraindicated. FBE can embolize or if large, cause obstructive events, such as myocardial infarction, CVA, TIA, sudden death when on the left side of the heart. If on the right side, pulmonary embolus can occur. Ngaage et al did shave excision (83%), excision (9%), or valve replacement (6%) of aortic valve FBE. After three years there was no tumor recurrence after three years. If a patient has symptoms, surgery is indicated. However, what about asymptomatic patients? Although guidelines are not present, one author felt that if the FBE is large (> 1cm) or mobile then increased risk demands that curative therapy be applied. However, left sided lesions that are small, immobile, and can be closely followed should be treated with anticoagulants until the FBE enlarges or symptoms occur. [The lesion was very small and only on some of the loops. On the loops that it was present, it was only present in one of the cardiac cycles and not the other. Therefore, for such a small thing to be found could only have been found by a princess since only they can feel a pea under their mattress :)] |
| Please answer the following questions correctly to obtain your CME. |
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.
= JPG Image
= GIF Image