Cardiac Hemangioma Mimicking Infective Endocarditis

Abstract

Cardiac hemangiomas are rare and often misdiagnosed due to their nonspecific clinical presentations. We report a case of a 70-year-old man presenting with chills and cold sweats, initially suspected of having infective endocarditis based on echocardiographic findings of a mobile mass on the mitral valve. Laboratory results showed leukocytosis and elevated C-reactive protein, but blood cultures were negative. Transesophageal echocardiography later revealed a well-defined mass with characteristics suggestive of a tumor. Surgical excision confirmed the diagnosis of hemangioma. Postoperative recovery was uneventful, with no mitral regurgitation. This case highlights the importance of considering cardiac tumors in the differential diagnosis of intracardiac masses.

Keywords: cardiac hemangioma; cardiac tumor; echocardiography; infective endocarditis.

Figure 1

(A) Four-chamber transthoracic echocardiography view showing a mobile mass (white arrow) on the posterior leaflet of the mitral valve. (B) Parasternal long-axis transthoracic echocardiography view showing a mobile mass (white arrow) on the posterior leaflet of the mitral valve (Video S1). (C) Transesophageal echocardiography showing a 1.9 × 1.4 cm polypoid mass with a pedicle attached to the annulus near the P2 segment. The mass partially protruded into the left ventricle during diastole (Video S2). (D) Transesophageal echocardiography showing a polypoid mass with a pedicle attached to the annulus near the P2 segment. Color Doppler indicated mild mitral regurgitation. Grading of the mitral regurgitation may have been underestimated due to the mitral mass obstacle (Video S3). Preoperative coronary artery angiography showed no obvious feeding arteries (Videos S4–S6).

Figure 2

(A) A round 1.5 × 1.5 × 1.5 cm tumor at the mitral annulus between P1 and P2. (B) A tumor on the posterior mitral annulus connected to underlying mitral annulus calcification. (C) Pathology showed hemangioma with dense lymphocyte infiltration (5× magnification). (D) CD34 stain revealed a capillary–cavernous hemangioma with dense lymphocyte infiltration (10× magnification).