Cardiac papillary fibroelastoma and cryptogenic stroke: a diagnostic and therapeutic challenge

Cardiac papillary fibroelastoma (CPF) is a rare, benign cardiac tumor with a significant risk for embolic complications, most notably ischemic stroke. This paper presents a case of a 54-year-old woman with cryptogenic stroke ultimately attributed to a CPF on the aortic valve, discovered via transesophageal echocardiography (TEE) after an initial unremarkable transthoracic study. Following diagnosis, the patient was treated with anticoagulation and scheduled for surgical excision. Although often asymptomatic, CPF can present with life-threatening embolic events, underscoring the importance of timely diagnosis through high-resolution imaging, particularly TEE. Surgical excision remains the definitive treatment in symptomatic or high-risk cases, but management of incidental, asymptomatic tumors remains controversial due to the absence of formal guidelines. This paper emphasizes the need for heightened clinical suspicion of CPF in cryptogenic stroke and advocates for individualized treatment approaches based on tumor characteristics and embolic risk.