Long term stability of a cardiac fibroma on serial CMR – Case Report

Presenting Author(s)

• 

  Fernanda Sayuri Oshiro, MD

  Cardiologist
  Universidade Federal de Mato Grosso do Sul, Universidade Federal de São Paulo
  Campo Grande, Mato Grosso do Sul, Brazil

Primary Author(s)

• 

  Fernanda Sayuri Oshiro, MD

  Cardiologist
  Universidade Federal de Mato Grosso do Sul, Universidade Federal de São Paulo
  Campo Grande, Mato Grosso do Sul, Brazil

Co-Author(s)

• RS

  Raul Serra Valerio

  Universidade Federal de São Paulo - Unifesp, Brazil
• AR

  Alfredo Rodrigues, MD

  Coordenador do Grupo de Imagem Cardiovascular DASA-SP
  Universidade Federal de São Paulo - Unifesp
  Sao Paulo, Sao Paulo, Brazil
• 

  Gilberto Szarf, MD, PhD

  Radiologist
  Hospital Israelita Albert Einstein
  Sao Paulo, Sao Paulo, Brazil
• 

  Marly Uellendahl, MD, PhD

  Cardiac Imaging Coordinator
  DASA - UNIFESP
  São Paulo, Sao Paulo, Brazil
• MS

  Maria Eduarda Menezes de Siqueira, MD,PhD

  Assistant
  Sociedade Brasileira de Cardiologia

Description of Clinical Presentation: A 21-year-old woman presented with exertional palpitations and dyspnea, prompting a cardiology workup. A resting 12‑lead ECG and 24‑hour Holter were unremarkable. Transthoracic echocardiography revealed a fixed, well-circumscribed mass involving the lateral wall of the left ventricle, exhibiting heterogeneous hyperechogenicity with internal punctate calcifications. The patient was referred for comprehensive cardiac magnetic resonance imaging (CMR) for further characterization. Cardiac fibroma was the leading diagnostic consideration. Over a 6-year follow-up period, the patient remained clinically stable, with serial CMR demonstrating no significant interval change in the mass's characteristics or dimensions. Accordingly, conservative management with continued surveillance was maintained.

Diagnostic Techniques and Their Most Important Findings: CMR was performed for detailed tissue characterization, the study revealed an intramyocardial mass with smooth margins involving the lateral wall of the left ventricle, measuring approximately 7.4 × 4.0 cm on four-chamber views.

The lesion demonstrated hypointensity on bSSFP cine and T2-weighted imaging and isointensity on T1-weighted imaging. Absent first-pass perfusion of the mass was noted, while LGE demonstrated intense, homogeneous late enhancement. Global left ventricular systolic function was preserved.

Learning Points from this Case:

• Cardiac fibromas usually arise within the ventricular myocardium and most often present as solitary, well-demarcated, nonencapsulated masses, with a predilection for the left ventricular free wall. Clinical manifestations are diverse and depend on tumor size and location.


• On CMR, fibromas typically appear T1 isointense to slightly hyperintense and T2 hypointense. They exhibit absent/minimal first-pass perfusion and avid, homogeneous late gadolinium enhancement, attributable to contrast pooling within the expanded fibrotic extracellular space. A central low-signal component may be observed, frequently indicating calcification.


• CMR is central in cardiac mass assessment: it is a noninvasive, radiation-free modality offering high spatial and temporal resolution, which enables multiparametric tissue characterization and accurate definition of tumor size, location, extent, and relationships to adjacent structures. Beyond its diagnostic utility, CMR contributes to prognostic evaluation, guides therapeutic strategy, and facilitates reproducible longitudinal follow-up.

Figure 1: Short-axis (A) and four-chamber (B), showing intramyocardial mass (*) hypointense on T2. 2016 (A) and 2020 (B).
Figure 2: Short axis (A) and four-chamber (B-C), presenting intramyocardial mass (*) isointense in T1. 2016 (A), 2018 (B), and 2020 (C).
Figure 3: Short-axis showing an intramyocardial mass (*) with LGE of intense and homogeneous pattern. 2014 (A), 2017 (B), and 2018 (C).