A 57-year-old man displayed chest tightness and nausea about two years, hospitalized to the First Affiliated Hospital of Zhejiang University (Hangzhou, China) in December 2020. The patient was in good condition generally, denying palpitations, syncope, chest pain and dyspnea. The blood pressure, heart rate, electrocardiogram and biochemical examinations were within the normal range. However, the right calcified cardiac border was found incidentally by chest X-ray. In addition, transthoracic echocardiography (TTE) revealed a 4.3cm × 0.7cm area of calcification within the myocardium located at the right ventricular anterior wall near the apical but the right ventricular wall motion was normal [Figure 1a]. The diagnosis of a benign pericardial tumor was confirmed through the computed tomography (CT) and three‐dimensional reconstruction imaging [Figure 1b-1c]. Intraoperative transesophageal echocardiography (TEE )identified a 3cm× 2cm hyperechoic mass in the apical interventricular groove stretching to the right ventricular anterior wall [Figure 1d].

The patient proceeded the surgical excision of the tumor under extracorporeal circulation state, and median sternotomy was executed. A protruding yellowish firm mass (3 cm × 3 cm ×2cm) close to the left anterior descending artery branch was discovered [Figure 2a]. Finally, he elastic tumor was carefully and completely resected without damaging the left anterior descending artery[Figure 2b].

Histopathologic examination showed that the mass was a fibroma, presenting as tumorlike fibrous tissue hyperplasia with abundant collagen fibers. No evidence of mitotic figures or malignancy was observed [Figure 3]. The patient recovered well after the operation and discharged at 8 days after surgery. Follow-up echocardiography was examined every 3 months postoperative, there is no evidence of recurrence and the patient remains asymptomatic.