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Case Reports
. 2024 May 18;2024(5):rjae321.
doi: 10.1093/jscr/rjae321. eCollection 2024 May.

Right ventricular outflow tract obstruction by cardiac hemangioma in asymptomatic patient

Naritsaret Kaewboonlert  1 , Piyapat Chunharas  2 , Naree Pluthikarmpae  3 , Jiraphon Poontananggul  1 , Akharawat Wongthep  1 , Natthipong Pongsuwan  1 , Udomsak Lerssuttipon  2
Affiliations
Case Reports

Right ventricular outflow tract obstruction by cardiac hemangioma in asymptomatic patient

Naritsaret Kaewboonlert et al. J Surg Case Rep. .

Abstract

Ventricular hemangiomas are rare benign tumors, pose diagnostic and therapeutic complexities. We report a case of a 52-year-old female with essential hypertension who developed a systolic ejection murmur during a hypertension clinic visit. The echocardiogram revealed a hyperechoic mass obstructing the right ventricular outflow tract, causing enlargement of the right atrium and ventricle, with a reduction in the right ventricular ejection fraction. Due to the risk of death, the patient underwent an emergency surgical resection along with tricuspid valve replacement. Postoperative recovery was uneventful, and subsequent cardiac magnetic resonance imaging showed an improvement in ejection fraction without residual tumor. This case highlights the diagnosis and therapeutic complexities of ventricular hemangiomas. With this report, we aim to provide a comprehensive review of ventricular hemangiomas and to enhance understanding of this condition for improved patient care.

Keywords: benign tumor; cardiac tumor; right ventricular outflow tract obstruction; ventricular hemangioma.

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Figures

Figure 1
Figure 1
Cardiac magnetic resonance imaging demonstrated T2 hyperintense partially mobile 60 × 39 × 46 mm mass occupying the right ventricular cavity and causing outflow tract obstruction (A). Comparison to post-surgical resection in picture (B) showed decreased right atrial and ventricular size, the tricuspid bioprosthetic valve in place, and right ventricular function returned to normal.
Figure 2
Figure 2
Intra-operative finding shows lobulated mass protruding from right atriotomy involving the anterior leaflet of the tricuspid valve (A). The gross pathological cut surface shows a polypoid mass with spongy appearance and focal fibrosis (B). Arrows are indicated anterior leaflet of the tricuspid valve.
Figure 3
Figure 3
Mixed cavernous-capillary hemangioma. The histologic examination reveals dilated thin-walled blood vessels (left upper) admixed with capillary-sized blood vessels (right lower) on fibrotic stroma (hematoxylin and eosin, 40x).
See this image and copyright information in PMC

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