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A 35–year–old woman with known mitral valve prolapse and history of migraine presented to the Emergency Department because of several episodes of chest pain in the previous three days arising at rest and followed by spontaneous relief within few minutes. No electrocardiographic abnormalities were found but an oscillating trend of high sensitivity Cardiac troponin I (hs–cTnI) was reported. After an urgent coronary angiography which showed non obstructive coronary artery disease, the patient was referred to intensive care unit (ICU) with a working diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA). Hence, an integrated imaging assessment was performed: trans–thoracic echocardiogram (TTE) and trans–esophageal echocardiogram (TEE) excluded segmental wall motion abnormalities and pericardial effusion but revealed a round–shaped hyperechoic floating mass attached to the aortic valve. Cardiac nuclear magnetic resonance (CMR) allowed to rule out an acute myocarditis and demonstrated on the T1–weightened imaging an isointense mass on the right cusp of the aortic valve. During the assessment of LGE in phase–sensitive inversion recovery (PSIR) the mass appeared hyperintense. The hypothesis of repetitive episodes of myocardial ischemia due to the transient obstruction of the coronary ostium determined by the pedunculated mass was formulated. After successful surgical excision, the histopathological examination of the specimen revealed mesenchymal tissue with the characteristics of cardiac papillary fibroelastoma (CPF).