Disclosures: Evan A. Plunkett, MD: No financial relationships or conflicts of interest

Case Description: A 52 year old male sustained a stroke and underwent extensive laboratory and diagnostic testing which was unremarkable. Due to waxing and waning neurological symptoms, advanced multiplanar transesophageal imaging was performed at the academic center which demonstrated an aortic valve fibroelastoma.

Setting: Tertiary care hospital.

Patient: 52 year old male with a past medical history of diabetes who had a left middle cerebral artery ischemic stroke. Assessment/

Results: Advanced multiplanar transesophageal imaging was performed at the academic center which demonstrated an aortic valve fibroelastoma.

Discussion: Papillary fibroelastoma is a surprisingly common primary valvular tumor. The incidence is as high as 0.33% in autopsy series. The mean age at diagnosis is 60, and its presence increases embolic stroke risk. There are a number of patients who routinely undergo acute diagnostic neurologic testing post stroke and are labeled cryptogenic, however this valvular lesion should be considered in the differential prior to giving this uncertain diagnosis. It is important to note that in this case, when utilizing transthoracic echocardiography, the aortic valve was visualized but no abnormalities were found. However, with the advanced multiplanar transesophageal study, the aortic valve fibroelastoma was visualized.

Conclusion: Transthoracic echocardiography is predominantly utilized during a stroke workup. However, if additional advanced testing returns unremarkable, prior to labeling the patient as cryptogenic, the clinician should consider a fibroelastoma in their differential and consider pursuing an advanced multiplanar transesophageal evaluation. This is crucial as this medical condition can be monitored and treated with an excellent prognosis. Effective treatment reduces an individual’s risk for recurrent stroke and further debility due to its embolic nature.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/fibroelastoma-in-cryptogenic-stroke/