Pathologically Proven Papillary Fibroelastomas Attached to the Left Atrial Appendage and Pulmonary Vein Ridge

Papillary fibroelastomas (PFEs) are the most common benign cardiac tumors, typically found on valvular surfaces but less frequently on extravalvular structures. Despite their benign nature, PFEs are associated with serious embolic events. This study analyzes 13 cases of pathology-proven PFEs in the left atrial appendage (LAA) and pulmonary vein ridge. Data on patient demographics, clinical presentations, imaging, and histopathology were reviewed. The median patient age was 73 years, with slight male predominance. Tumor sizes ranged from 2 mm to 20 mm. Twelve PFEs were detected via transesophageal echocardiography, and neurologic events were observed in 4 patients. This case series emphasizes the importance of maintaining a broad differential diagnosis for LAA masses because PFEs can easily be mistaken for thrombi.