A pedunculated left ventricular hemangioma initially misdiagnosed as thrombus in a woman with atypical chest pain

Abstract

The incidence of cardiac masses increased as echocardiography is becoming increasingly popular. Benign tumors of the heart constitute about 72% of all primary cardiac neoplasms and hemangioma accounts for 5-10% of benign cardiac tumors. Cardiac hemangiomas are generally asymptomatic and diagnosed incidentally during echocardiography or magnetic resonance imaging (MRI). We reported a 52-year-old woman presented with atypical chest pain and exertional dyspnea. The echocardiographic examination revealed a hyperechoic round mass in the left ventricle. With an initial diagnosis of left ventricular thrombus, the patient underwent cardiac MRI. The mass was found compatible with cardiac hemangioma. It was removed surgically and histopathologic evaluation identified a cardiac hemangioma. As reports of cardiac hemangioma are extremely rare and cardiac masses are mostly thought to be thrombi or myxomas (being the most common primary cardiac tumor), such hemangioma cases warrant attention as possibility of hemangioma should also be kept in mind.

Right atrium hemangioma in patient with history of mixed‐thrombus surgery

“…There are only 200 cases of hemangiomas reported in the literature according to our review article in 2015; however, this is partly because some were misdiagnosed as thrombi or cardiac myxomas . Similarly, the initial preoperative diagnosis of our case was also challenging, because the existence of the cardiac thrombus surgical history, combined with the new neoplasm revealed by the echocardiogram, led us to believe that it was a myxoma, since this is the most common type of tumor in the heart . However, seeing the morphology of the tumor in surgery, we began to doubt this conclusion.…”

“…3,4 Similarly, the initial preoperative diagnosis of our case was also challenging, because the existence of the cardiac thrombus surgical history, combined with the new neoplasm revealed by the echocardiogram, led us to believe that it was a myxoma, since this is the most common type of tumor in the heart. 1,2 However, seeing the morphology of the tumor in surgery, we began to doubt this conclusion.…”

“…A cardiac mass can be an intracardiac thrombus, primary or secondary cardiac tumors, cysts, or valvular vegetations of infective endocarditis . Primary cardiac neoplasms are rare, around 0.28% at autopsy and cardiac hemangiomas are even rarer, accounting for only 5% of those .…”

Left Ventricular Hemangioma

“…They generally involve the apex of the left ventricle, most often in the presence of akinesis or dyskinesis. The differential diagnosis included a cardiac myxoma, although myxomas usually occur in the left atrium in 75% of the cases; only 5% of them develop in the left ventricle [Tanrikulu 2009]. For further evaluation of the mass, we performed CT and MRI scans.…”