Introduction: Although papillary fibroelastomas are rare benign primary tumors, they are the most com-mon valvular tumors (90%). Left ventricular valves are more often interested: aortic valve (44%), mitral valve (35%), rarely the right ventricular valves – tricuspid valve (15%) and the least the pulmonary valve – PV (8%). On the semilunar valves, they are inserted on their ventricular side and on the atrioventricular valves on the atrial side. They are often asymptomatic, being accidentally discovered, or due to their friable charac-ter, patients present with cardioembolic complications. The diagnosis is supported by the echocardiographic characteristics of the tumor (round, well defined, pediculated, hyperechogenic, with a shiny aspect, mobile with the valve movements, small sized – 1cm) and the typical “sea anemone” macroscopic appearance, the diagnosis of certainty requiring anatomopathological examination. The aim of this paper is to emphasize the importance of echocardiography in the detection of benign a- or paucisymptomatic primary tumors.

Methods: We present the case of a 68-year-old hyper-tensive patient, diagnosed from a young age with COPD, addressed at the Cardiology Clinic of “St. Spi-ridon” Iasi with progressively aggravated dyspnea, in which transthoracic and transesophageal echocardio-graphy revealed a PV located formation suggestive for fibroelastoma.

Results: Clinical, normal pulmonary auscultation, Sp02 97% aa, BP=135/95 mmHg, rhythmic HR=90/ minute, systolic 3/6 grade murmur in the aortic area, bilateral varicose veins. Electrocardiography, RS=90/ minute, intermediate AQRS, normal morphology. Transthoracic echocardiography (TTE) reveals normal sized left cavities, slightly dilated right ventricle (RV), apical hypertrophied, with a formation inside it, which seems to be attached to PV, moderate secondary pul-monary hypertension, minor mitral regurgitation, aor-tic atheromatosis, normal LV contractility, LVEF 60%, without pericardial fluid. Transesophageal echocardio-graphy complements the images obtained at TTE with 10/10 mm rounded, well-defined, pediculated, atta-ched to the left cusp of PV on the ventricular face, whi-ch enters intermittently in the pulmonary artery (PA) trunk, synchronous with the valve movements. Thora-cic angio-CT highlights: dilated RV, dilated PA trunk (38 mm), 29 mm right PA, 24 mm left PA, dilated right subsegmental branches, PA filling defect.

Conclusions: The particularity of the case is the rare localization at the PV of a primary valve tumor which, in the absence of imaging examinations, especially the echocardiographic ones, has long been misinterpreted as a pulmonary disease. Because of the risk of the em-bolic complications, surgical resection is indicated; has good prognosis and is not usually followed by tumor recurrence. Long-term prophylactic anticoagulation may be considered in elderly patients with high surgi-cal risk.