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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidental detection of aortic valve fibroelastomas during endoscopic ultrasound for pancreatic evaluation: Three case reports
Ghassan Elsayed, Lama Mohamed, Maryam Almasaabi, Khalid Barakat, Rama Taha, Mohammed S AlQahtani, George Makdisi, Mohamed Musa, Abdulrahman Alfadda, Eyad Gadour
Ghassan Elsayed, Lama Mohamed, Maryam Almasaabi, Khalid Barakat, Rama Taha, Mohamed Musa, Department of Gastroenterology, Mediclinic Middle East Hospital, Abu Dhabi W67, United Arab Emirates
Mohammed S AlQahtani, Eyad Gadour, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
Mohammed S AlQahtani, Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
George Makdisi, Department of Cardiology, Mediclinic Middle East Hospital, Abu Dhabi W67, United Arab Emirates
Abdulrahman Alfadda, Department of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
Eyad Gadour, Department of Medicine, Faculty of Medicine, Zamzam Univeristy College, Khartoum 11113, Sudan
Author contributions: Elsayed G, Mohamed L, Almasaabi M, Barakat K, and Gadour E contributed to conceptualization, data collection, manuscript writing, and revision, endoscopic procedures and data interpretation; Elsayed G, Makdisi G, Musa M, and Gadour E contributed to radiological analysis; Elsayed G and Gadour E contributed to project supervision, critical review, and final approval of the manuscript; Taha R, AlQahtani MS, Musa M and Alfadda A contributed to data analysis, manuscript writing, and critical review. All authors have read and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Eyad Gadour, Consultant, FACP, FRCP, MRCP, Professor, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Dammam 32253, Saudi Arabia.
eyadgadour@doctors.org.uk
Received: April 10, 2025
Revised: May 25, 2025
Accepted: September 11, 2025
Published online: November 6, 2025
Processing time: 203 Days and 10.2 Hours
BACKGROUND
Papillary fibroelastomas are rare, benign cardiac tumors typically found on the heart valves. This case series presents three patients with aortic valve fibroelastoma incidentally detected during endoscopic ultrasound (EUS) for pancreatic and biliary pathologies. These cases highly get the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation, raise important questions about the true prevalence of these lesions, and highlight the need for established guidelines for their management and surveillance. The detection of fibroelastomas during routine EUS procedures emphasizes the importance of thorough assessment and multidisciplinary approaches in managing unexpected discoveries. This also highlights the potential thromboembolic risks associated with fibroelastomas and challenges in determining appropriate management strategies for patients who are asymptomatic.
CASE SUMMARY
The patients aged 72 years, 51 years, and 42 years underwent EUS for various indications when aortic valve lesions consistent with fibroelastomas were discovered. These findings were subsequently confirmed by transesophageal echocardiography in two cases, with the third patient awaiting assessment. The lesions ranged in size from 0.61 cm to 1.6 cm in diameter and exhibited characteristic sonographic features of fibroelastomas, including hyperechoic appearance and attachment to the aortic valve leaflets. These cases highlight the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation, raising questions about the true prevalence of fibroelastomas and the need for establishing management guidelines.
CONCLUSION
This case series raises important questions regarding the prevalence of aortic valve fibroelastoma lesions in the general population. This highlights the urgent need for comprehensive evidence-based guidelines to standardize the management and long-term surveillance of affected patients.
Core Tip: This case series presents three instances of aortic valve fibroelastoma detected during endoscopic ultrasound for pancreatic and biliary pathologies. These serendipitous findings highlight the potential of endoscopic ultrasound in identifying subtle cardiac lesions during gastrointestinal evaluations. These cases raise important questions regarding the true prevalence of fibroelastomas and highlight the need for established guidelines for their management and surveillance. This series emphasizes the importance of thorough assessments and multidisciplinary approaches in managing unexpected discoveries, while also highlighting the potential thromboembolic risks associated with fibroelastomas and the challenges in determining appropriate management strategies for asymptomatic patients.
