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Images in Clinical Medicine

Papillary Fibroelastoma of the Pulmonary Artery

Takeshi Kondo, M.D., and Satoshi Tobe, M.D.

N Engl J Med 2007; 356:e1January 4, 2007

Article

A 74-year-old man underwent an ultrasonographic examination of the right upper quadrant as part of an evaluation for a hepatoma. Incidentally, a tumor in the pulmonary artery, filling the space over the pulmonary valve, was noted. On questioning, he reported no cardiac symptoms. At surgery, the tumor, located near the pulmonary valve (Panel A, arrow), had a short stalk connected to the valvular commissure. Macroscopically, it had a characteristic flower-like appearance, and, immersed in water, it looked like a sea anemone (Panel B). The tumor was histologically diagnosed as a papillary fibroelastoma covered with CD34-positive endothelial cells. This tumor is a benign avascular growth of the endocardium with a matrix consisting of mucopolysaccharides. The patient had an uneventful course after the operation.

Takeshi Kondo, M.D.
Satoshi Tobe, M.D.
Kobe University Graduate School of Medicine, Kobe 650-0017, Japan