Cardiac Papillary Fibroelastoma Mimicking Infective Endocarditis in an Octogenarian: A Case Report

Introduction: Papillary fibroelastoma is a rare benign cardiac tumor, usually discovered incidentally or during evaluation for embolic events. Its echocardiographic appearance often mimics infective endocarditis, making diagnosis challenging. Case Presentation: We report the case of an 83-year-old man with a history of hypertension and hypercholesterolemia, presenting with progressive dyspnea, orthopnea, and angina. Initial evaluation revealed elevated biomarkers and pulmonary edema. Transthoracic and transesophageal echocardiography showed a mobile mass attached to the posterior mitral leaflet, raising suspicion of infective endocarditis. However, blood cultures remained negative, and PET scan was inconclusive. The patient underwent surgical excision, and histopathological examination confirmed a papillary fibroelastoma. Postoperative evolution was favorable. Conclusion: Papillary fibroelastoma should be considered in the differential diagnosis of valvular masses. Multimodal imaging is crucial, but histology remains the gold standard. Early surgical excision is recommended in symptomatic patients, even in advanced age, to prevent embolic complications.