Background <p>Papillary fibroelastoma is a rare, benign cardiac tumor that typically originates from the cardiac valves, with papillary muscle involvement being extremely rare. However, optimal management of papillary fibroelastoma remains variable.</p> Case presentation <p>A 79-year-old female with multiple comorbidities, including Parkinson’s syndrome, diabetes, and frailty, was referred to our hospital because an incidental left ventricular mass was detected during a preoperative evaluation for knee osteoarthritis. Echocardiography and computed tomography revealed a mobile, 17-mm mass in the left ventricle, possibly attached to the posterior papillary muscle. The morphological findings were suspicious for papillary fibroelastoma. The tumor was surgically resected from the papillary muscle using a three-dimensional thoracoscopy-assisted right limited-thoracotomy approach. Histopathological analysis confirmed the diagnosis of papillary fibroelastoma. Postoperatively, the patient was discharged without complications, and no recurrence was observed at the 1-year follow-up.</p> Conclusion <p>This case demonstrates the feasibility and efficacy of minimally invasive video-assisted right thoracotomy for the resection of a papillary fibroelastoma originating from the papillary muscle.</p>