Rare presentation of cardiac hemangiomas

doi:10.1016/S0003-4975(00)01666-0

The Annals of Thoracic Surgery

Volume 70, Issue 3, September 2000, Pages 977-979

https://doi.org/10.1016/S0003-4975(00)01666-0 Get rights and content

Abstract

Cardiac hemangiomas are exceptionally rare tumors with an incidence of 1% to 2% of all detected benign heart neoplasms. The clinical appearance of the tumor varies considerably and may mimic other pathological findings of definite heart structures. We report two cases of cardiac hemangiomas presenting with an unusual location and clinical course.

Section snippets

Case 1

A 74-year-old male was admitted for coronary artery bypass grafting. He had stable angina with T-wave changes and first-degree atrioventricular block evident in the electrocardiogram. Ischemia was demonstrated in the treadmill protocol and triple-vessel disease was found at angiography. The left ventricular ejection fraction was preserved with 65%. At elective surgery, an unexpected mass arising from the anterior wall of the right ventricle displacing the right coronary artery was found. This

Comment

Hemangiomas are benign primary tumors responsible for less than 2% of all heart neoplasms. They may arise both from the epicardium and myocardium but are also found in cardiac cavities. Therefore, the spectrum of clinical symptoms is broad: from pericardial effusion to dysrrhythmia, from signs of heart failure to pseudo-angina when tumor tissue compresses epicardial coronary arteries 5, 6.

The presented cases illustrate well the variety of clinical presentation due to the different localization.

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Cited by (24)

Dyspnea and Chest Pain in a Young Woman Caused by a Giant Pericardial Lymphohemangioma: Diagnosis and Treatment
2016, Canadian Journal of Cardiology
Citation Excerpt :
There are fewer than 2 dozen cases of cardiac lymphangioma in the literature, the majority occurring in patients younger than 10 years of age.2 Given the low likelihood of spontaneous resolution and high recurrence rates, complete surgical resection is recommended in symptomatic patients.3 A single case of a cardiac lymphohemangioma has been reported.4
We describe a 21-year-old woman who presented with chest pain and dyspnea on exertion and who was found to have a large pericardial mass. Multimodality imaging was instrumental in narrowing the differential diagnosis and planning surgical treatment, which included coronary artery bypass and right-sided heart reconstruction. The final pathologic diagnosis was lymphohemangioma; to our knowledge, this was the largest cardiac/pericardial vascular tumor ever to be reported in the literature.
Nous décrivons le cas d’une femme âgée de 21 ans qui consulte en raison de douleurs thoraciques et de dyspnée à l’effort, et chez qui une masse volumineuse a été découverte au péricarde. L’imagerie multimodale a permis de restreindre le diagnostic différentiel et de planifier le traitement chirurgical, qui comprenait un pontage aortocoronarien et une reconstruction cardiaque droite. Le diagnostic pathologique final était un lymphohémangiome; à notre connaissance, il s’agit de la plus grosse tumeur vasculaire cardiaque/péricardique jamais signalée dans la littérature.
Cardiac hemangioma: A comprehensive analysis of 200 cases
2015, Annals of Thoracic Surgery
Citation Excerpt :
Specifically, the right atrium was the most common location (26.2%). Of all the cases involving the septum, two of them were simply related to interatrial septum [15, 16] and three were confined to the interventricular septum alone [9, 17, 18], without extending into the cardiac chambers. In terms of the site of origin, we found that most of the CH originated in the left ventricle (20.2%), whereas the aortic valve was the least possible site (1.0%) [14, 19].
Cardiac hemangioma is a rare clinical entity. An increasing number of cases have been reported in recent years. Most of them were found incidentally at autopsy or during clinical practice, and reported as isolated cases. Our study is the most comprehensive review of cardiac hemangioma to date. The clinical demographics, clinical features, histopathologic features, treatment, and prognosis of 200 cases are reported. Logistic regression analysis was performed to identify the independent predictors of hemangioma-related death and long-term adverse events. We provide a few recommendations for diagnosis and treatment of this uncommon and sometimes lethal disorder.
Management of right atrial hemangioma in a patient with antithrombin deficiency
2015, Annals of Thoracic Surgery
Citation Excerpt :
In our patient, we also used AT-III concentrate and heparin to maintain AT-III activity up to 80% perioperatively, facilitating an uneventful cardiac operation. Cardiac hemangioma is rare and accounts for approximately 2% of all primary cardiac tumors [5]. Its symptoms are nonspecific, and the tumor is usually detected incidentally.
Hereditary antithrombin (AT) deficiency is an autosomal dominant inheritance disorder. Patients with AT deficiency have a high risk of thromboembolism, and intraoperative cardiopulmonary bypass management is difficult. We present the case of a 53-year-old man who was diagnosed with AT deficiency and who underwent an open heart operation for a right atrial hemangioma. We administered AT-III concentrate perioperatively to maintain his AT-III level up to 80% to establish cardiopulmonary bypass and prevent thromboembolic events postoperatively. The right atrial hemangioma was successfully excised after right atriotomy. The patient had an uneventful postoperative course and was discharged on postoperative day 14.
Coronary and atrial compression by a giant cardiac hemangioma
2014, Cardiovascular Pathology
Citation Excerpt :
The growth rate of hemangiomas is unpredictable: they may proliferate, remain stable or regress; recently, 43% increase in tumor size over approximately 1 year was reported by two serial positron emission tomography scans [5]. A rapid growth may cause various symptoms due to compression of adjacent cardiac structures [1,2,6]: particularly, myocardial ischemia due to extrinsic coronary compression by a hemangioma has been rarely described [7]. Cardiac CT and CMR are complementary techniques, both crucial to the accurate noninvasive diagnosis of cardiac masses [8].
A 57-year-old asymptomatic man showed a round echo-dense mass, partially occupying the left atrium on echocardiography. Magnetic resonance localized the mass in the atrioventricular groove, inside the pericardial space, and showed a large hepatic mass too. Computed tomography revealed significant compression of the left main coronary artery and of the left pulmonary veins outlet. The tumor was surgically removed and diagnosed as hemangioma. Heart hemangiomas are extremely rare; they are usually asymptomatic but sometimes they grow rapidly, causing various symptoms. In our case, life-threatening compression of the left main coronary artery and of the pulmonary veins warranted the intervention.
Cardiac cavernous hemangioma and multiple pulmonary cavernous hemangiomas
2014, Annals of Thoracic Surgery
Citation Excerpt :
The histologic classification includes capillary, cavernous, and arteriovenous hemangiomas, but the cause is not yet very clear. Cardiac hemangiomas are exceedingly rare, representing only 1% to 2% of all detected benign heart neoplasms [1]. They can occur at any age and in any layer of the heart, including the epicardium, myocardium, and endocardium [2], although the epicardium is the most common location [3].
We describe for the first time a rare coexistence of a cardiac cavernous hemangioma with multiple pulmonary cavernous hemangiomas. Computed tomography revealed bilateral pulmonary nodules, left pleural effusion, and pericardial effusion. Positron emission tomography showed a pericardial neoplasm. Pathologically, multiple large dilated vascular spaces, lined by a single layer of endothelial cells and filled with blood, were revealed in both the cardiac tumor and the pulmonary nodules. Immunohistochemical examination of the lining cells showed positivity for CD31, FLI1, FVIII, and CD34. Taken together, these findings led to the diagnosis of cardiac cavernous hemangioma and multiple pulmonary cavernous hemangiomas.
Successful detection and surgical treatment of cardiac hemangioma with right ventricular invasion
2013, Annals of Thoracic Surgery
Cardiac hemangiomas are extremely rare benign tumors. These tumors are usually asymptomatic but they can present symptoms such as palpitations, shortness of breath, and arrythmia. We report the case of a 73-year-old man who presented with an abnormal shadow on chest computed tomography during follow-up for lung metastatic tumor after resection of his rectal cancer. A cardiac tumor was detected, and surgical resection and right ventricular plasty were successfully performed with the patient under cardiopulmonary bypass. Histopathologic examination revealed a benign cardiac hemangioma, which was categorized as a hemangioma of the mixed cavernous and capillary type.

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Case reportRare presentation of cardiac hemangiomas

Abstract

Section snippets

Case 1

Comment

Ann Thorac Surg

Ann Thorac Surg

Frühresultate nach chirurgischer Behandlung von Herztumoren

Schweiz Med Wschr

Surgical pathology of primary cardiac and pericardial tumors

Eur J Cardiothorac Surg

Case report
Rare presentation of cardiac hemangiomas