Right Atrial Cardiac Hemangioma: A Multidisciplinary Pathway From Symptoms to Surgery

Abstract

We present a case of a 76-year-old man with de novo right heart failure. Echocardiography initially detected a mass near to the posterior area of the right atrium. Despite a comprehensive multimodality imaging assessment, the exact location of the mass remained unclear. Positron emission tomography scan revealed comparable hypermetabolic activity to that of the bloodstream, suggestive of a vascular tumor. Surgical resection via right anterior mini-thoracotomy confirmed an intracardiac mass that was ultimately diagnosed as a capillary hemangioma. This case underscores the challenges in the era of advanced cardiac imaging modalities in precisely localizing and characterizing masses, particularly rare entities such as cardiac hemangiomas.

Keywords: cardiac hemangioma; cardiac masses; multimodality imaging.

Graphical abstract

Figure 1

The Multidisciplinary Pathway Leading to Diagnosis of Right Atrial Cardiac Hemangioma (A) Computed tomography scan (axial view, soft tissue window) showing a mass (open arrow) in the posterior area of the right atrium. (B) Cardiac magnetic resonance showing heterogeneous late gadolinium enhancement within the mass. (C) Transesophageal echocardiography showing the mass to localize adjacent to the posterior and inferior regions of the right atrium, in a posterior right position relative to the coronary sinus. (D) Fluorodeoxyglucose F 18–positron emission tomography (axial view) revealing mild uptake within the mass, with a maximum standard uptake value of 4.5 comparable to that of the bloodstream (maximum standard uptake value of 4.3). (E) Perioperative view of the mass. (F) Postoperative image showing complete resection of the mass. Solid arrow shows a solid nodular lesion.