Sudden Death in a Child Revealing a Multifocal Cardiac Fibroma: A Hidden Lethal Threat.
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Despite their benign histology, cardiac fibromas can cause life-threatening complications, including arrhythmias and sudden death. We report the case of a previously healthy four-year-old boy who collapsed suddenly after a minor fall. Despite immediate resuscitation efforts, he was declared dead. Autopsy revealed an enlarged heart with a large, firm, white intramyocardial mass measuring 5.5 × 4.5 × 3.0 cm in the lateral wall of the left ventricle, compressing the ventricular cavity. Three additional epicardial nodules were also identified. Histologic examination showed spindle cell proliferation with dense collagenous stroma, low mitotic activity, and no atypia or necrosis, consistent with multifocal cardiac fibroma. This case illustrates the silent yet potentially lethal nature of cardiac fibromas in children. Multifocal presentation is extremely rare and can remain undiagnosed until sudden death occurs. Awareness of such tumors and early cardiac imaging may help prevent fatal outcomes in pediatric populations.