A case of a small-sized cavernous hemangioma in the right ventricle - an incidental finding

Abstract

A cardiac cavernous hemangioma is a rare, primary, benign tumor that is usually diagnosed in young or middle-aged patients. In this article, we report the case of a 71-year-old male patient whose doctors incidentally discovered a heart tumor on his transthoracic echocardiography. Triple-phase computed tomography (CT) (pre-contrast, arterial and portal venous) missed the lesion, and magnetic resonance imaging (MRI) revealed a small, oval tumor attached to the wall of the right ventricle. The tumor was successfully removed surgically, and the patient recovered after 2 weeks. A histopathological examination resulted in the diagnosis of a benign cavernous hemangioma.

Keywords: Cardiac tumor; Cavernous hemangioma; Computed tomography (CT); Echocardiography; Magnetic resonance imaging (MRI).

Fig. 1

Transthoracic echocardiographic images. A, B: 2-chamber views showed an oval isoechoic mass (arrow) attached to the right ventricular lateral wall and changed shape according to the heart contraction. C: 4-chamber view showed the mass protruding into the right ventricular chamber. RV-Right ventricle, LV-Left ventricle, RA-Right atrium, LA-Left atrium.

Fig. 2

Chest CT axial images at the arterial (A1, A2, A3) and portal venous phases (V1, V2, V3) showed no mass in the right ventricular chamber. RV-Right ventricle, LV-Left ventricle, RA-Right atrium, LA-Left atrium.

Fig. 3

Cardiac magnetic resonance images. T2W: Two-chamber view showed a mass (arrow) which was isointensive as compared with the myocardium and attached to the right ventricular wall (A); STIR: The mass was hyperintensive on the short-axis views, 17 × 14 × 13mm in size (B); Perfusion and LGE: Diffused enhancement at the first-pass perfusion and LGE images (C, D). Ao-Aorta, RV-Right ventricle, LV-Left ventricle, STIR-Short tau inversion recovery, LGE-Late gadolinium enhancement.

Fig. 4

Images of the perfusion sequence, including plain and the early stage images of the same level showed the contrast agent was gradually and diffusely absorbed into the mass (arrow).

Fig. 5

Image of an oval mass, attached to the right ventricle wall, revealed during open heart surgery, measuring 16 × 14 × 15 mm and partially covered by a thin capsule.

Fig. 6

This histological image (HE x 200) showed multiple dilated and tortuous vessels intervening fibrous stroma, the dilated vascular spaces lined with a single layer of flat endothelial cells (green arrow), clusters of red blood cells inside the vascular lumen (orange arrow) (Color version of figure is available online).