Fibroelastoma as a Culprit of Syncope

We present a case of a valvular mass diagnosed by emergency department bedside ultrasonography in a young patient with syncope. Bedside ultrasound has become a valuable tool in the evaluation of patients with syncope in the emergency department. This patient was believed to have a fibroelastoma on ultrasound that was confirmed by magnetic resonance and ultimately by postsurgical pathological evaluation. The indications and findings of using ultrasonography as part of the workup of syncope in the emergency department are discussed. 1. Introduction Papillary fibroelastomas (PFE) are the most common tumors of the cardiac valves and the third most common tumors of the heart [1, 2]. Although they are usually not clinically significant and histologically benign, they have been associated with valvular dysfunction, increased risk for embolic events, and even myocardial infarction [1, 3]. We will present the case of a 36-year-old female who suffered a syncopal episode while sitting at her computer. She had no prior episodes of syncope, no systemic signs of illness, and no prior history of intravenous drug abuse. A bedside emergency room ultrasound showed a hyperechoic lesion on the right cusp of the aortic valve concerning for a vegetation, but in this case, it was also concerning for a cardiac tumor. 2. Case The patient is a 36-year-old female with past medical history of ocular migraines who presented to the emergency department complaining chest pressure and mild shortness of breath. She had a syncopal episode 5 days prior to our hospital visit and was seen and admitted at an outside hospital. Neuroimaging was done as part of her initial syncope workup with negative findings. She signed out against medical advice from the outside hospital, and as she was driving near our facility she developed chest pain. Her family urged her to stop at our emergency department for further evaluation. Patient had never had similar previous chest pain prior to these episodes. On exam, she had intermittent chest pain located mid to left substernal and described as a “constant dull pressure” (up to severity 6/10). She had no worsening or alleviating factors, and her discomfort was nonpleuritic. She had also described dizziness, palpitations, and mild shortness of breath. An electrocardiogram showed sinus rhythm with a rate of 67, and no other abnormalities were noted. Cardiac enzymes were negative. No focal deficits on neurological exam and no cranial nerve deficits were observed. A bedside echocardiogram showed a hyperechoic well-circumscribed lesion on the right cusp of the