ON THE COVER A healthy 44-year-old man presented to the emergency department with aphasia. The magnetic resonance imaging (MRI) scan of the brain revealed multiple bihemispheric strokes suggesting cardiac emboli (A). The transesophageal echocardiography showed a highly mobile echogenic and spherical mass attached to the auricular aspect of the anterior mitral leaflet (B). Although with these ultrasonographic features, endocarditis, thrombus, and cardiac tumors should be ruled out, these findings point to papillary fibroelastoma. He reported no fever and blood cultures were negative. A cardiac MRI rejected the presence of lipid components or attached thrombi (C) on a mass that showed enhancement caused by fibroelastic tissue. The tumor was removed by simple surgical excision and the leaflet repaired with a pericardial patch (D, E). The macroscopic characteristics were consistent with the above studies, and histology confirmed the diagnosis (F). The post-operative course was successful, and he remains asymptomatic. The echocardiogram and cardiac MRI provide valuable guidance to assay morphologic and tissue characterization of cardiac masses. Image provided by: David Gabriel Doiny, MD, Ricardo Spampinato, MD, Christian Adrián Caroli, MD, Hernán Cohen Arazi, MD, Hugo Grancelli, MD, FACC, Carlos Nojek, MD, Claudio Pensa, MD, from the Cardiovascular Department in FLENI, Buenos Aires, Argentina.

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