Dynamic obstruction of right coronary ostium by a papillary fibroelastoma: a case report on alternative causes of chest pain and cardiac imaging assessment

Papillary fibroelastomas (PFEs) are one the most common primary cardiac tumours. Although they are benign, their location involves a high risk of adverse events, which have been reported mainly in the form of embolic events, but angina pectoris is another possible, less frequent manifestation.

We present a case of a 72-year-old woman with chest pain symptoms, who was found to have a PFE. As part of pre-operatory study a computed tomography (CT) scan was performed which documented dynamic obstruction of the right coronary artery. Surgery was brought forwards and mass was resected with histology confirming PFE.

The interest of our case lies into the documentation of the obstruction with the scan, highlighting the role and advancements of this diagnostic technique and the importance of a prompt assessment and management of these patients, since previous clinical evidence has shown that ischaemia due to PFEs could present with acute coronary syndromes or even sudden cardiac death.