Lambl's excrescences are usually described as filiform (threadlike) fronds.  They were first described by Vilem Dusan Lambl, a Bohemian physician.

They occur, by definition, along valve closure lines, where minor endothelial damage promotes thrombus formation and deposition of layers of mucopolysaccharide matrix. They occur most commonly attached to aortic valve cusps. Most patients are asymptomatic. However, excrescences can embolise in which case the consequence may be an embolic stroke. In such cases, anticoagulation is usually considered. Patients suffering multiple embolic strokes are offered surgical debridement of excrescences (other causes having been excluded). Asymptomatic patients should be monitored for embolic events.

Papillary fibroelastomas are microscopically similar though the term tends to be applied to larger lesions. They are also usually attached to valve cusps or leaflets but can occur away from valve closure lines and on the endocardial surfaces of atria and ventricles.

PLAX 2D Aortic valve with Lambl’s excrescence
Dr Jeff Ball


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