Lambl’s excrescences: A case report and review of the literature

Kamran, Haroon; Patel, Nirav; Singh, Gagandeep; Pasricha, Venu; Salifu, Moro; McFarlane, Samy I.

doi:10.15761/ccrr.1000254

Cited by 22 publications

(19 citation statements)

References 13 publications

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“…These filiform strands are often incidental finding and may confuse clinicians to differentiate between mobile thrombus or pedunculated myxoma or cardiac papillary fibroelastomas. There are several evidences to support that these clusters of LE may break from the atrioventricular valve and cause thromboembolic events and predispose the patients to adverse events like myocardial infarction, stroke, pulmonary embolism, ventricular fibrillation, and retinal artery embolism [2,[4][5][6][7][8][9][10]. LE should be considered in the differential diagnosis for a patient with embolic stroke of undetermined source.…”

Section: Discussionmentioning

confidence: 99%

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Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Patel

Bhesania

Malik

et al. 2019

SN Compr. Clin. Med.

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Background Lambl's excrescence (LE) is a rare thin, mobile, filiform frond on the endocardial surface of cardiac valves responsible for recurrent ischemic strokes due to embolic phenomena. Due to nonspecific symptoms, sometimes the diagnosis is challenging. It can be diagnosed by transesophageal echocardiogram (TEE) with increased sensitivity. Several case reports have been published with a strategy to manage LE but there is lack of consensus. We report a case of a 75-year-old patient with the LE arising from aortic valve resulting in recurrent ischemic strokes within a short period and its management. Case A 75-year-old male with multiple vascular risk factors presented with confusion, altered mental status of unknown onset and aphasia. He denied weakness, numbness, or other focal neurological deficits. National Institute of Health Stroke Scale was 5. IV tPA was not given due to the unknown onset of symptoms. The magnetic resonance imaging (MRI) revealed acute/subacute left thalamic lacunar infarct. TEE demonstrated a 7-mm linear fibrinous mass on the valve. The patient was on aspirin which was changed to clopidogrel. After 2 weeks, the patient readmitted with similar presentation. MRI showed subacute right parietal cortical infarct. The patient was advised to proceed with surgical resection of LE. Due to refusal for surgery, he was kept on 30 days cardiac monitor and had given anticoagulant therapy for secondary prevention of stroke. Conclusion Although wide range from single or dual antiplatelet therapy to full dose anticoagulation have been tried, surgical intervention should be considered in case of multiple ischemic strokes to mitigate the risk of embolism.Keywords Lambl's Excrescence . Cardiac tumor . Papillary fibroelastomas . Acute ischemic stroke . Embolic stroke . Embolic stroke of undetermined source (ESUS) Urvish K. Patel and Siddharth Bhesania contributed equally to this work.

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Section: Discussionmentioning

confidence: 99%

“…There is no established evidence for the management and treatment of LE [8]. When a LE is detected by TEE, antiplatelet therapy should be considered.…”

Section: Discussionmentioning

confidence: 99%

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Patel

Bhesania

Malik

et al. 2019

SN Compr. Clin. Med.

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“…Thrombi, seen in patients with atrial fibrillation, coronary heart disease, and dilated cardiomyopathy, may become calcified and layered, with poor mobility . Lambl's excrescences occur at the sites of valve closure, and are associated with minor endothelial damage after valve wear and tear …”

Section: Discussionmentioning

confidence: 99%

“…9 Lambl's excrescences occur at the sites of valve closure, and are associated with minor endothelial damage after valve wear and tear. 11 While it is commonly agreed that surgical resection is an optimal treatment for symptomatic PFE patients, there is controversy regarding the treatment for asymptomatic patients. 12 Surgical removal is a reasonable approach and is recommended when PFE is discovered during cardiac surgery due to other causes.…”

Section: Case Reportmentioning

confidence: 99%

Incidental finding of an asymptomatic pulmonary valve papillary fibroelastoma: A case report

Guo

Yang

Liu

et al. 2019

J of Clinical Ultrasound

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Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left‐side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.

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“…These papillary projections give fibroelastomas characteristic stippled edges on echocardiographic imaging [32]. Fibroelastomas may be mistaken for Lambl's excrescences, which are mobile frondlike lesions that occur along lines of valve closure [33]. Interestingly, there have been some anecdotal reports of spontaneous regression.…”

Section: Papillary Fibroelastomasmentioning

confidence: 99%

Non-Malignant Cardiac Tumors

Eapen¹,

Malone²,

Hanna³

et al. 2020

Embolic Diseases - Evolving Diagnostic and Management Approaches

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Cardiac tumors represent an unusual clinical problem in that they are often discovered as an incidental finding during a routine echocardiogram or in the course of a work-up for a source of embolism. Malignant tumors of the heart are either defined as primary or metastatic from an extra-cardiac primary sourceregardless, the prognosis is poor. However, there are several cardiac tumors that are characterized as being non-malignant with regard to their tumor biology, but their tendencies to cause embolic or obstructive complications can be just as catastrophic despite a lack of invasiveness or potential to metastasize. The purpose of this chapter is to review the common types of non-malignant cardiac tumors with regard to their incidence, presentation, potential for complications, and management-with emphasis on surgical indications and techniques. 2 delineated as malignant and non-malignant with malignant tumors being either primary (i.e., cardiac sarcomas) or metastatic (i.e., breast carcinoma). They are distinguished from non-malignant tumors, such as myxomas and fibroelastomas, in that the latter, despite the pathologic implications of growth (i.e., valvular obstruction) and systemic embolism, lack true metastatic potential. Nevertheless, non-malignant cardiac tumors can be clinically devastating (i.e., malignant) by their tendency to cause potentially devastating, and occasionally fatal, embolic complications [5]. MethodsThe focus of this review is on non-malignant tumors. The review methods consisted of Google Scholar (https://scholar.google.com) and PubMed (https:// www.ncbi.nlm.nih.gov/pmc/) searches with emphasis on the following key words: cardiac tumors, benign cardiac masses, myxomas, fibroelastomas, and fibromas. Additional associated search terms included: surgery, diagnosis, imaging, and management. Selected references, including manuscript abstracts and full texts, were reviewed for relevance in the context of this review.

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Lambl’s excrescences: A case report and review of the literature

Cited by 22 publications

References 13 publications

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Lambl’s Excrescence Associated with Recurrent Ischemic Strokes

Incidental finding of an asymptomatic pulmonary valve papillary fibroelastoma: A case report

Non-Malignant Cardiac Tumors

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