{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:34:30Z","timestamp":1781660070101,"version":"3.54.5"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>Papillary fibroelastoma (PFE) is a rare benign cardiac tumor, usually left-sided and valvular. Right-sided, non-valvular PFEs are uncommon, and systemic embolization from these lesions is particularly rare, typically requiring an interatrial shunt. We report a surgically confirmed right-atrial, non-valvular PFE presenting with paradoxical embolic stroke through an ostium secundum atrial septal defect (ASD). A 72-year-old woman with recurrent ischemic cerebrovascular events was admitted with an acute posterior circulation stroke. Transthoracic echocardiography was nondiagnostic. Transesophageal echocardiography revealed a 13 x 14 mm highly mobile mass attached to the free wall of the right atrium and an ostium secundum ASD (about 9\u201310 mm) with bidirectional shunting. Surgical resection of the mass with concomitant ASD closure was performed 14 days after the index stroke. Gross inspection suggested a frond-like tumor; histopathology confirmed PFE. Postoperative recovery was uneventful. Anticoagulation was resumed for a new distal deep-vein thrombosis, and no further embolic events have occurred during follow-up. This case illustrates an unusual mechanism of systemic embolism from a right-sided, non-valvular PFE via paradoxical embolization through an ASD. It emphasizes the limitations of transthoracic echocardiography in detecting small or atypically located PFEs and supports transesophageal echocardiography as the modality of choice when clinical suspicion persists. In symptomatic patients or after embolism, surgical excision, particularly with simultaneous closure of right-to-left shunts, should be considered to minimize recurrence risk. Clinicians should include PFE in the differential diagnosis of recurrent cryptogenic stroke and actively search for interatrial shunts when right-sided tumors are suspected.<\/jats:p>","DOI":"10.1177\/23247096261452104","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:14:28Z","timestamp":1778771668000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Right Atrial Non-Valvular Papillary Fibroelastoma Causing Paradoxical Embolic Stroke Through an Ostium Secundum Atrial Septal Defect: A Case Report"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5920-9979","authenticated-orcid":false,"given":"Ivan Felipe","family":"Manrique Osorio","sequence":"first","affiliation":[{"name":"Pontificia Universidad Javeriana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Rebolledo","sequence":"additional","affiliation":[{"name":"Pontificia Universidad Javeriana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Pontificia Universidad Javeriana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Bohorquez","sequence":"additional","affiliation":[{"name":"Pontificia Universidad Javeriana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.02.077"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-021-01526-7"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccao.2020.05.009"},{"key":"e_1_3_6_5_2","first-page":"1027","article-title":"Tumors of the heart: a 20-year experience with a review of 12,485 consecutive autopsies","volume":"117","author":"Chan A","year":"1993","unstructured":"Chan A, Dickens P, Lam K. Tumors of the heart: a 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993;117:1027-1031.","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-206665"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rccar.2017.05.007"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58020182"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.049569"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(75)90003-4"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1053\/hupa.2002.130105"},{"key":"e_1_3_6_12_2","first-page":"832","article-title":"Cardiac valve papillary fibroelastomas: clinical, histological and immunohistochemical studies and a physiopathogenic hypothesis","volume":"9","author":"Grandmougin D","year":"2000","unstructured":"Grandmougin D, Fayad G, Moukassa D, et al. Cardiac valve papillary fibroelastomas: clinical, histological and immunohistochemical studies and a physiopathogenic hypothesis. J Heart Valve Dis. 2000;9:832-841.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carpath.2019.01.007"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(14)80260-5"},{"key":"e_1_3_6_15_2","first-page":"587","article-title":"Embolismo cerebral de repetici\u00f3n en una enferma portadora de fibroelastoma papilar de la v\u00e1lvula mitral, detectado mediante ecocardiograf\u00eda bidimensional","volume":"43","author":"Ortiz de Mur\u00faa JA","year":"1990","unstructured":"Ortiz de Mur\u00faa JA, Hernando E, Arenas C, Duarte J, Fern\u00e1ndez Calella D. Embolismo cerebral de repetici\u00f3n en una enferma portadora de fibroelastoma papilar de la v\u00e1lvula mitral, detectado mediante ecocardiograf\u00eda bidimensional. Rev Esp Cardiol. 1990;43:587-589.","journal-title":"Rev Esp Cardiol"},{"key":"e_1_3_6_16_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7812\/TPP\/21.069","article-title":"Rare cardiac papillary fibroelastoma: right atrial, non-valvular, large, symptomatic with pulmonary embolism","volume":"25","author":"Prasad RM","year":"2021","unstructured":"Prasad RM, Osman A, Garces CC, et al. Rare cardiac papillary fibroelastoma: right atrial, non-valvular, large, symptomatic with pulmonary embolism. Perm J. 2021;25:1-4.","journal-title":"Perm J"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(91)90113-Y"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)71175-4"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.22.2687"},{"key":"e_1_3_6_20_2","first-page":"47","volume-title":"Tumors of the heart and great vessels. AFIP Atlas of Tumor Pathology","author":"Burke A","year":"1996","unstructured":"Burke A, Virmani R. Papillary fibroelastoma. In: Tumors of the heart and great vessels. AFIP Atlas of Tumor Pathology. Washington, DC: AFIP; 1996:47-54."},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2021.03.114"},{"key":"e_1_3_6_22_2","first-page":"e26722","article-title":"A case of recurrent embolic strokes in a young female with a patent foramen ovale and presumed fibroelastoma","volume":"14","author":"Abdelsayed N","year":"2022","unstructured":"Abdelsayed N, Parza K, Faris M. A case of recurrent embolic strokes in a young female with a patent foramen ovale and presumed fibroelastoma. Cureus. 2022;14:e26722.","journal-title":"Cureus"},{"key":"e_1_3_6_23_2","first-page":"47","article-title":"A case of a fibroelastoma and patent foramen ovale in a patient with prior stroke","volume":"4","author":"Vaskelyte L","year":"2014","unstructured":"Vaskelyte L, Risteski P, Bertog S, Hofmann I, Hartmann S, Sievert H. A case of a fibroelastoma and patent foramen ovale in a patient with prior stroke. Cardiovasc Diagn Ther. 2014;4:47-49.","journal-title":"Cardiovasc Diagn Ther"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(03)00249-7"},{"key":"e_1_3_6_25_2","first-page":"49","article-title":"Right auricular fibroelastoma and paradoxical embolic stroke","volume":"54","author":"Vandergoten P","year":"1999","unstructured":"Vandergoten P, Dendale P, Geukens R, et al. Right auricular fibroelastoma and paradoxical embolic stroke. Acta Cardiol. 1999;54:49-50.","journal-title":"Acta Cardiol"}],"container-title":["Journal of Investigative Medicine High Impact Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096261452104","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23247096261452104","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096261452104","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:16:53Z","timestamp":1778937413000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23247096261452104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":24,"alternative-id":["10.1177\/23247096261452104"],"URL":"https:\/\/doi.org\/10.1177\/23247096261452104","relation":{},"ISSN":["2324-7096","2324-7096"],"issn-type":[{"value":"2324-7096","type":"print"},{"value":"2324-7096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"article-number":"23247096261452104"}}