PMC3806706_01
A, B Apical four-chamber 2D and echocardiographic color flow views. C, D Avascular branching filamentous fronds with a single endothelial cell covering, fibrous core and loose connective tissue rich in mucopolysaccharide.
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F1
A pedunculated mass with peripheral shimmering frond-like appearance and stalk attached to the septal TV leaflet was seen prolapsing through the TV with tricuspid regurgitation (fig. 1A, B). Each frond had a fibrous core with loose connective tissue rich in mucopolysaccharide (fig. 1C, D).
A, B CT pulmonary angiogram with contrast showing a right-sided TV tumor.
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F2
CT pulmonary angiography did not show gross filling defects to suggest pulmonary embolism (PE) but revealed a mobile mass visible in the orthogonal image planes (fig. 2A, B).
A TV-PF visualized by FIESTA (bright-blood MRI imaging sequence) with hyperintense signal relative to the myocardium, but hypointensity relative to the blood pool. B Axial FIESTA sequence showing the same pedunculated tumor attached to the TV. C, D Hyperintense tumor signal with inversion recovery T2 sequences and delayed gadolinium hyperenhancement.
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F3
Cardiac MRI revealed a mobile mass measuring >=1 cm in multiple dimensions, showing hyperintensity on T2-weighted and inversion recovery sequences (fig. 3A-D).