Giant Cardiac Fibroma in a Completely Asymptomatic Teenager

We report the case of a 19 years old “healthy” and asymptomatic patient accessing the Emergency Room after a car accident trauma. A routine electrocardiogram documented an intraventricular conduction disturbance. The subsequent transthoracic echocardiogram showed the presence of a voluminous heterogeneous intracardiac mass (10 × 10 × 8 cm), localized in the medium-apical cavity of the right ventricle and extended to the outflow tract. A mass debulking intervention was performed and the intraoperative biopsy samples allowed the diagnosis of cardiac fibroma. Because of dimension, intracardiac infiltration and relations, radical surgery was not an option; the patient was candidate for heart transplantation. This unique case highlights the questionable classification of cardiac fibromas as benign and the possibility of a delayed diagnosis because of late clinical presentation.