Papillary fibroelastoma (PFE) is a rare benign cardiac tumor, typically originating from valvular structures. Nonvalvular PFEs are exceedingly uncommon and can present with diverse clinical manifestations. We report a case of a 46-year-old woman with a history of hypertension and dyslipidemia who presented with transient positional vertigo and exertional dyspnea. Initial neurological assessment and brain imaging were unremarkable. However, transthoracic echocardiography revealed a mobile, oval-shaped mass within the left ventricle. Cardiac magnetic resonance imaging characterized the mass as a 23.5 × 19.6 × 16.5 mm lesion attached to the papillary muscle, with imaging features consistent with PFE. Surgical excision was performed through a median sternotomy, and the tumor was successfully resected without complications. Histopathological examination confirmed the diagnosis of PFE. The patient had an uneventful recovery, and follow-up imaging showed no evidence of recurrence or mitral valve dysfunction. This case highlights the importance of multimodal imaging in the diagnosis and management of cardiac tumors, particularly nonvalvular PFEs, which can present with atypical symptoms. Due to the risk of embolization and hemodynamic complications, prompt recognition and surgical removal of large, mobile PFEs are crucial. Although minimally invasive techniques may be considered in select cases, open surgical excision remains the gold standard for large and mobile tumors.