Cardiac hemangioma is an uncommon benign tumor most frequently located in the epicardium but also described within the myocardium and endocardium. 1 We report a rare case of a giant right atrial mixed hemangioma and describe the correlation among echocardiographic, magnetic resonance, intraoperative, and histologic imaging.
CLINICAL SUMMARYA symptom-free 74-year-old man was referred to our hospital with an incidentally found huge right atrial mass. On physical examination, significant findings included normal blood pressure, lack of jugular venous distention, normal carotid and peripheral pulses, and clear lung fields. On auscultation, S 1 and S 2 were normal, and no extra heart sounds were heard. The electrocardiogram exhibited a normal sinus rhythm with left axis deviation. Chest radiography revealed cardiomegaly. A transthoracic echocardiogram showed a large, rounded, echo-bright mass containing hypoechoic areas (Figure 1, A-C). The mass was located within the right atrium and attached to the lateral wall, with no hemodynamic obstruction.Cardiac magnetic resonance imaging was requested for tissue characterization. This technique demonstrated a huge (55 3 50 mm), well-circumscribed mass with a broad base of attachment arising from the right atrial posterior wall up to the superior vena cava. The lesion had intermediate signal intensity on T1-weighted images and was hyperintense on T2-weighted images (Figure 1, D). A heterogeneous hyperintense enhancement immediately after gadolinium injection demonstrated a high vascularized mass (Figure 1, E). Coronary angiography showed a rich vascular tumor blush that originated from the right coronary artery (Figure 1, F).At surgery, an enormous (6 3 6 cm) tumor was completely resected (Figure 2, A), and its feeding vessel coming from the right coronary artery was ligated. In addition, a portion of the right atrial wall was removed and replaced with autologous pericardium (Figure 2, B).Macroscopic evaluation showed a reddish blue encapsulated tumor with an irregular surface (Figure 2, C). In a cross-From the Departments of