Copyright © 2006, The European Society of Cardiology
Cardiac hemangioma presenting as atypical chest pain
Cardiologic Hospital, Pessac, Bordeaux 2 University, France
Received 25 October 2005; received in revised form 20 December 2005; accepted after revision 6 January 2006.
* Corresponding author. Hopital Cardiologique du Haut-Leveque, Service Pr Roudaut, Avenue de Magellan, 33604 Pessac, France. Tel.: +33 557656565/56485; fax: +33 557656012. karimserri{at}hotmail.ca
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A 44-year-old man presented with atypical chest pain and dyspnea. Investigation revealed the presence of a 15-mm rounded, well-vascularized left-ventricular mass. The mass was removed surgically and histopathologic evaluation identified a cardiac hemangioma.
Keywords: Cardiac tumor; Echocardiography
A 44-year-old man was investigated for atypical chest pain and exertional dyspnea. Physical examination, ECG and chest radiograph were unremarkable. Transthoracic echocardiography (Fig. 1A) revealed the presence of a 15-mm rounded, slightly mobile mass attached to the anterolateral wall of the left ventricle (LV) in proximity to the papillary muscle, without signs of valvular dysfunction or obstruction. These findings were confirmed by a transesophageal examination (Fig. 1B). Coronary angiography showed late opacification of a well-vascularized LV mass (Fig. 2). Computed tomography and magnetic resonance imaging did not reveal any myocardial invasion. Through an aortotomy approach, complete surgical excision of an oval-shaped 15x20mm mass was performed, without the need for LV or valvular reconstruction. Histopathologic evaluation revealed vascular proliferation suggestive of a mixed capillary-cavernous hemangioma.
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Cardiac hemangiomas are very rare benign cardiac tumors, representing less than 3% of all primary cardiac tumors. They can be pericardial, intramyocardial or subendocardial in location. Age at presentation can range from infancy to late adulthood. Clinical presentation is highly variable according to the location, size and extension of the tumor. Symptoms include congestive heart failure, pericarditis, pericardial effusion, arrythmias and thromboembolic complications. The natural history is unpredictable, as the tumor may remain clinically silent or grow to produce symptoms. Diagnosis is typically made by echocardiography, computed tomography or magnetic resonance imaging. Coronary angiography will often reveal a characteristic "tumor blush" highlighting the vascular nature of the tumor. Contrast imaging (using either computed tomography, magnetic resonance or echocardiography) can help to differentiate nonvascularized cardiac masses (such as thrombi) from tumors, as well as improve tumor characterization and border delineation. Treatment usually involves surgical resection, often because of diagnostic uncertainty about the nature of the tumor.
Interestingly, one case of spontaneous regression has been reported.1 Long-term prognosis is favourable, but recurrence following surgical excision has been documented.2 The patient was last seen at one-year follow-up and remains asymptomatic without any evidence of echocardiographic recurrence.
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- Palmer T.E., Tresch D.D., Bonchek L.I. Spontaneous resolution of a large, cavernous hemangioma of the heart. Am J Cardiol (1986) 58(1):184–185.[CrossRef][Web of Science][Medline]
- Colli A., et al. Recurrence of a right ventricular hemangioma. J Thorac Cardiovasc Surg (2003) 126(3):881–883.
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