Spontaneous right atrial rupture caused by a papillary fibroelastoma: a case report

Abstract Background Spontaneous rupture of the right atrium is an extremely rare event, most commonly associated with trauma, infarction, or malignant infiltration. Papillary fibroelastoma is a benign cardiac tumor typically involving valvular surfaces and has not been previously reported as a cause of atrial wall rupture. Case presentation We describe a 53-year-old woman presenting with sudden hemodynamic collapse due to massive pericardial effusion. Computed tomography revealed hemopericardium without evidence of aortic or coronary rupture. Emergency surgery identified active bleeding from the right atrial free wall, with a friable nodular lesion in direct continuity with the rupture site. Histologic appearance and gross morphology were consistent with papillary fibroelastoma. The patient recovered uneventfully after surgical repair. Conclusions This case highlights an unprecedented presentation of papillary fibroelastoma causing spontaneous right atrial rupture. Prompt imaging and surgical exploration are essential for diagnosis and management of unexplained cardiac tamponade.