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Cardiovascular Images

Malignant Presentation of Cardiac Hemangioma

A Rare Cause of Complete Atrioventricular Block

Chien-Lung Huang, MD; An-Ning Feng, MD; Yi-Cheng Chuang, MD; Gong-Yan Lan, MD; Ming-Chon Hsiung, MD, PhD; Jing-Ying Lee, MD; Wei-Hsian Yin, MD, PhD and Mason Shing Young, MD

From the Division of Cardiology (A.-N.F., M.-C.H., W.-H.Y.), Department of Cardiovascular Surgery (Y.-C.C.), Department of Medical Imaging (G.-Y.L.), Division of Pathology (J.-Y.L.), and Department of Internal Medicine (M.S.Y.), Cheng-Hsin Rehabilitation Medical Center, Taipei, Taiwan.

Correspondence to Chien-Lung Huang, MD, and Wei-Hsian Yin, MD, PhD, Division of Cardiology, Cheng-Hsin Rehabilitation Medical Center, No. 45, Cheng-Hsin St, Pei-Tou, Taipei 112, Taiwan. E-mail clhuang0130@yahoo.com.tw and yin.wh@msa.hinet.net

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 46-year-old woman suffered effort intolerance for months. She had been healthy in the past, without systemic diseases. She had experienced near-syncope before arrival at our center. On admission, her physical examination was unremarkable. ECG exhibited normal sinus rhythm, P pulmonale, and first-degree atrioventricular (AV) block. A transthoracic echocardiogram demonstrated a huge right atrial (RA) mass, 7.98x5.70 cm in size, with 23 mm Hg of transvalvular pressure gradient. The global ventricular contractility was normal (Data Supplement Movies I and II). These findings were confirmed by 3-dimensional echocardiography (Figure 1; Data Supplement Movies III and IV). Cardiac magnetic resonance imaging showed a large, well-defined intracavity mass on T1-weighted image. After contrast injection, delayed images revealed a strong signal indicating hypervascularity (Figure 2 and online-only Data Supplement), highly suggestive of hemangioma, angioma, or angiosarcoma. Coronary angiography failed to locate the feeding artery, but RA and right ventricular angiography showed a large space occupied by the lesion (Figure 3).

View larger version (52K):   Figure 1. Three-dimensional echocardiogram demonstrates significant dilatation of the RA with a huge, solid RA mass protruding into the right ventricle through the tricuspid valve. H indicates hemangioma; RV, right ventricle; and LV, left ventricle.

 

View larger version (132K):   Figure 2. Cardiac magnetic resonance imaging documents the presence of a delayed high-signal mass (*) in the RA on T1-weighted image after gadolinium contrast injection. The cavernous type of cardiac hemangioma tends to not show a rapid signal enhancement with contrast administration because of the slow blood flow.4

 

View larger version (108K):   Figure 3. RA and . . . [Full Text of this Article]