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A 66-year-old woman was referred for investigation of syncope, dyspnea, and mild chest discomfort. A transthoracic echocardiogram revealed a mass attached to the atrial aspect of the septal leaflet of the tricuspid valve. Blood cultures were immediately taken to rule out a differential diagnosis of infective endocarditis. The patient underwent successful surgery to excise the mass and preserve the tricuspid apparatus. Surgical pathology confirmed the diagnosis of a papillary fibroelastoma. Surgical intervention should be considered in these cases due to the risk of embolization, and the possibility of malignant tumors. This case is a good example of why a complete echo should be done on each patient. Each valve should be thoroughly interrogated. It is also a good reminder to sonographers; knowledge of the characteristics of intracardiac masses is important.
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