Papillary Fibroelastoma Originating From the Coumadin Ridge

BACKGROUND: Papillary fibroelastomas are rare, benign cardiac tumors with potential for systemic embolization. Although typically valvular, they may arise in unusual locations and are often detected incidentally during cardiac imaging. CASE SUMMARY: A 76-year-old woman with chronic kidney disease and severe aortic stenosis presented with progressive fatigue and dyspnea. Preoperative imaging for aortic valve replacement revealed a left atrial mass. Transesophageal echocardiography demonstrated a mobile, gelatinous lesion arising from the Coumadin ridge. The mass was surgically excised concurrently with bioprosthetic aortic valve replacement. Histopathology confirmed papillary fibroelastoma. DISCUSSION: Nonvalvular papillary fibroelastomas are uncommon and may be overlooked. Their mobility confers significant embolic risk, supporting surgical removal, particularly when cardiac surgery is already planned. TAKE-HOME MESSAGES: Papillary fibroelastomas can occur in rare, nonvalvular locations. Careful imaging is essential for diagnosis and risk assessment. Surgical excision is effective and should be considered to prevent embolic complications.