Background
Primary cardiac tumors are rare, accounting for only 0.002-0.03% at autopsy. Cardiac hemangiomas are benign vascular tumors and constitute for 0.28% of all primary cardiac tumors. Cavernous hemangiomas, capillary hemangiomas and arteriovenous hemangiomas are three distinct types. Cardiac hemangiomas are often misdiagnosed as myxomas and must be differentiated from malignant angiosarcomas.
Case Summary
We present a 44-year-old Mediterranean male patient with a cavernous hemangioma in the inferior vena cava and right atrium, detected on transthoracic echocardiography. The patient experienced palpitations and dyspnea on exertion. CT angiography revealed a 7.5 x 6 x 5cm mass suspected to be perfused by the distal right coronary artery. A watch-and-wait approach was suggested, leading to a Cardiac MRI with contrast six months later. T1-mapping exhibited a prolonged relaxation time and isointensity to the myocardium. T2-mapping revealed a homogenous hyperintense mass with heterogenous Late-Enhancement. Surgical excision was performed using a bicaval cannulation technique on cardiopulmonary bypass. Intraoperatively, no connection to the coronaries was noted. At one year follow-up, the patient reported restored physical resilience, with no evidence of tumor recurrence.
Discussion
Clinical symptoms of cardiac cavernous hemangiomas are unspecific and become evident once the tumor grows. To investigate the nature and vascular involvement of the tumor, a contrast-enhanced CT angiography or MRI can be performed. Cardiac hemangiomas are often misdiagnosed and must be differentiated from malignant angiosarcomas. Clear guidelines for the treatment of cardiac hemangiomas in adult patients are lacking. Primary cardiac tumors require thorough investigation, and surgical intervention should be tailored to the individual's case.
