- Cardiac hemangiomas are exceptionally rare tumors with an incidence of 1 % to 2% of all detected benign heart neoplasms. Obstruction of the right ventricular outflow tract (RVOT) by a primary cardiac tumor is even rarer. To date, eleven cases of RVOT obstruction by a primary cardiac hemangioma have been reported and this is the first case in our institution. We report a case of a 3 5-year-old female presented at our institution with the chief complaint of progressive easy fatigability and exertional dyspnea of 4 months duration with grade 3/6 systolic murmur at 2nd to 4th ICS left parasternal area. Chest X-ray showed normal size heart with bulging of the left median curve. Echocardiography (ECG) showed sinus rhythm with septal wall ischemia. Transthoracic and transesophageal echocardiography confirmed the presence of an inhomogenous, irregularly shaped, confluent, mobile, lobulated mass in the right ventricular outflow tract before the pulmonic valve attached to the proximal interventricular septum. On computed tomo-graphic (CT) scan of the chest, a dilated and tortous enhancing structures along the groove of the interventricular septum which is intimately related to the dilated pulmonary artery was noted. An angiography was contemplated but it was deferred since the initial consideration was a myxoma.
The patient underwent elective excision of the cardiac mass. Grossly, the heart was noted to have dilated coronary arteries. On operation, arteriovenous malformation was noted just below the pulmonic valve attached to the septal wall. Excision and antero-ligation of the arteriovenous malformation was done. On histologic examination, the specimen consisted of several irregular fragments of tan-white, soft tissues altogether measuring 4x4x1 cm. Microsections showed fibrocollagenous tissue with variably sized vascular channels lined by a single layer of endothelium with some areas exhibiting calcification. Conclusion was vascular malformation consistent with cardiac hemangioma. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day. (Author)
1. To present a rare case of cardiac hemangioma presenting as right ventricular outflow tract mass.
2. To discuss the presentation, diagnosis, and management of cardiac hemangioma.
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