A 67-year-old woman with a past history of hypertension and type 1 diabetes mellitus, complicated by ischaemic heart disease, retinopathy and nephropathy, presented with several months of worsening dyspnoea and clinical signs of right heart failure. Transthoracic echocardiogram (TTE) showed normal left ventricular systolic function with a restrictive pattern of diastolic filling, a mildly dilated right ventricle with mild systolic impairment and a moderately elevated estimated pulmonary arterial pressure of 67 mmHg. Ventilation-perfusion imaging showed extensive, unmatched, non-segmental loss of perfusion bilaterally. This may have indicated multiple pulmonary emboli but due to the non-segmental pattern other aetiologies such as pulmonary hypertension could not be excluded.Subsequently, CT pulmonary angiography found no evidence of thrombo-embolic disease but noted a rounded 10 mm filling defect adjacent to or on one of the leaflets of the pulmonary valve. Repeat TTE delineated a mobile echo-dense mass attached to the pulmonary valve measuring 10 mm2, consistent with the differential diagnosis of a papillary fibroelastoma.© 2008 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.