Central retinal artery occlusion in a patient with aortic valve papillary fibroelastoma: a case report.

Background: Cardiac papillary fibroelastoma are rare benign tumours of the endocardium, often arising from heart valves. Despite their benign histology, papillary fibroelastoma carry high embolic potential and can lead to ischaemic events. In contrast to stroke, ocular embolization including central retinal artery occlusion is a rather rare first manifestation. Case summary: We report a 61-year-old female with sudden painless monocular vision loss due to central retinal artery occlusion. Initial stroke and cardiovascular work-up revealed a very small floating mass (0.6 × 0.4 × 0.2 cm) on the aortic valve by transesophageal echocardiography. The patient underwent successful surgical excision, with histopathology confirming papillary fibroelastoma. Discussion: Central retinal artery occlusion as a primary manifestation of papillary fibroelastoma highlights the embolic potential of these tumours. Multimodality imaging, especially transesophageal echocardiography, is crucial in diagnosis. Even very small papillary fibroelastoma may cause devastating embolic events such as irreversible monocular blindness. Surgical excision is the treatment of choice to prevent recurrence.