Cardiac hemangioma of the right atrium
Silme ´ia Garcia Zanati1*, Joa ˜o Carlos Hueb1, Ana Lu ´cia Cogni1, Maria Gorete Teixeira de Morais1,
Luiz Eduardo de Almeida Prado Franceschi2, Maurı ´cio Morceli3, Antonio Carlos Cicogna1,
and Beatriz Bojikian Matsubara1
1Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (UNESP), CEP18618-000,
Botucatu, Sa ˜o Paulo, Brazil;2Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista (UNESP),
Sa ˜o Paulo, Brazil; and3Department of Radiology, Botucatu Medical School, Universidade Estadual Paulista (UNESP),
Sa ˜o Paulo, Brazil
Received 14 July 2006; accepted after revision 20 August 2006; online publish-ahead-of-print 10 October 2006
Primary cardiac tumors are rare, with an incidence range between 0.001% and 0.030% at autopsy. Recent
technical advances have facilitated diagnosis and surgical treatment of such lesions. Patients with a
resectable tumor usually have a good prognosis, but patients with an unresectable tumor may have a
poor prognosis. This report shows a case of right atrial hemangioma growing like an extracardiac
mass, with cardiac tamponade the only clinical presentation.
Cardiac hemangiomas are exceptionally rare with only a
1–2% incidence in all detected benign heart neoplasms.1
Tumors with extracardiac extension are rarely symptomatic
and found by chance.2This report shows a case of right atrial
hemangioma growing like an extracardiac mass, with
cardiac tamponade as the only clinical presentation.
A white 30-year-old male was seen at the University Hospital
in January 2002 with cough and chest pain for the past 5
days. At physical examination, it was found arterial blood
pressure of 100 ? 80 mmHg, heart rate of 120 bpm, mild
jugular ingurgitation, and regular cardiac rhythm without
Chest radiography showed increased heart size. Electro-
cardiogram showed a low voltage complex and sinusal
large pericardial effusion and signs of cardiac tamponade.
Closed pericardiocentesis showed bloody effusion without
neoplastic cells at cytopathological examination. Biochemi-
cal tests were normal. The patient was discharged after
clinical improvement. Four months later, he was rehospita-
lized because of severe dyspnea and reported a 12 kg body
weight loss. Echodopplercardiogram revealed a large mass
filling the right atrium, right ventricle and pericardial
space, restricting the ventricle filling (Figure 1A). A chest
computed tomography (CT) showed a hypodense hetero-
geneous mass, measuring 13 ? 11 ? 12 cm, with outer
lining well defined by the pericardium (Figure 1B).
Surgical approach was unable to completely remove the
tumor. Histological exam showed a benign vascular neoplasia
with hyalinized stroma and deposits of hemosiderin, without
architectural disarrangement, being defined as a combi-
nation of cavernous and capillary types (Figure 2A and B).
Interferon therapy was initiated without success. One
month later, the patient had sudden cardiac death.
Cardiac hemangiomas grow from the benign proliferation of
endothelial cells and may occur in any part of the heart,
being more common in the right heart chambers.3–6Histo-
logically they are classified into three types: tumors com-
posed of multiple, dilated, thin walled vessels (cavernous
type), smaller capillary-like vessels (capillary type), and
dysplastic arteries and veins (arteriovenous type). A combi-
nation of cavernous and capillary types are more frequently
Most cardiac hemangiomas are asymptomatic, discovered
incidentally by echocardiography, CT, MRI or at autopsy.1,5
Symptomatic patients present arrhythmias, pericardial effu-
sions, congestive heart failure, right ventricular outflow
tract obstruction, embolic episodes, myocardial ischemia,
and sudden death. Although echocardiography may provide
*Corresponding author. Tel: þ55 14 3882 2969; fax: þ55 14 3882 2238.
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Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2006.
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European Journal of Echocardiography (2008) 9, 52–53
by guest on May 18, 2011
the information needed for surgical treatment, cardiac
catheterization and MRI are more precise for diagnosis.7
Differential diagnosis of mass lesions in the heart include
thrombi, myxoma, lipoma, fibroma, cyst, and other malig-
nant tumors such as angiosarcoma. The outcomes of
cardiac hemangioma are unpredictable. Patients with an
unresectable tumor may have a poor prognosis because of
ventricular tachycardia, sudden death, local progression,
or systemic dissemination of the malignant tumor.8
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pericardial tamponade from atrial hemangioma. Ann Thorac Surg 2004;
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hemangioma with papillary endothelial hyperplasia: report of resected
case and review of the literature. Ann Thorac Surg 1990;49:305–8.
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years’experience with 71 patients. Cancer 1997;79:1809–15.
8. Tomizawa Y, Endo M, Nishida H, Kikuchi C, Koyanagi H. Reconstruction of
the left ventricle in a patient with cardiac hemangioma at the apex.
Ann Thorac Surg 2001;71:2032–4.
(B) Showing the cells with no signs of malignancy (magnification ?400; arrows: hemosiderin deposits).
(A) Histological aspect of the tissue (Hematoxylin and Eosin, magnification ?100) showing the vascular aspect of the hemangioma.
extensive area occupied by the tumor (arrow). RV, right ventricle; RA, right atrium.
(A) Transthoracic four-chamber view echocardiograph of the hemangioma, (arrow). (B) Chest computed tomography showing the
Cardiac hemangioma of the right atrium 53
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