Introduction: Papillary fibroelastomas are rare and benign cardiac tumors in young patient. The most common clinical presentation is completed stroke or transient ischemic attack caused by emboli.

Observation: A 36-year-old man who presented to the neurology department at Fann teaching hospital(Senegal), reported a fall and transient loss of consciousness. The physical examination revealed weakness of the left arm and leg. On admission, physical examination showed that he was in sinus rhythm, had a pulse rate of 80 bpm, and a blood pressure of 108/69 mm Hg. On auscultation, he had murmur of 4/6th breath. 

Cerebral CT-scan revealed a hypodensity in the territory of the right middle cerebral artery. Laboratory tests were normal. He had a normal chest X-ray. The electrocardiography showed: a ventricular extrasystole sinus rhythm, left ventricular hypertrophy. Transthoracic echocardiography showed: moderate dilatation of the Lateral Ventricle, calcified thickened aortic sigmoid with restriction of the left anterior sigmoid leading to a central coaptation defect responsible for a major leak. Presence of highly mobile hyperhecogenous mass appended to the anterior surface of the left ventricular flushing chamber. Trans-esophageal echocardiography: severe rheumatic aortic insufficiency with presence of evoking aortic papillary fibroelastoma on the left anterior sigmoid. The patient has been on anticoagulant and is waiting for surgery.

Comment and conclusion: Cardiac papillary fibroelastoma is a rare cause of ischemic stroke. Transoesophageal echocardiography may be essential for easy diagnosis, and should be performed to make the appropriate diagnosis. Careful attention should be paid in order to find these masses in echocardiography.

Aortic fibroelastoma, rare cause of ischemic stroke in a young man: a case report