PERICARDIAL VASCULAR MALFORMATIONS – CASE REPORT AND REVIEW OF LITERATURE

Abstract

Intrapericardial haemangiomas are rare benign lesions representing 1-10% of all benign cardiac tumors. Although mostly asymptomatic, they can cause pericardial effusion, murmur, arrhythmia, tamponade and even sudden cardiac death. In this paper we present the case of a 54-year-old female patient whose only complaint was prolonged cough after an episode of common cold. Physical examination as well as complete biochemical laboratory findings were within normal limits. The patient was sent for additional imaging due to the unexpected finding of enlarged cardiac silhouette detected on chest X-ray. Transthoracic echocardiography depicted hyperechoic mass, elongating the left ventricular cavity, but not infiltrating it. There was early arterial blush on postcontrast cardiac magnetic resonance imaging with  centripetal contrast dynamics on a later T1 vibe. The intermediate-to-high signal on T1-weighted images, and diffusely high signal on T2-weighted images were in favor of highly vascularized mass. Contrast enhanced computer tomography revealed huge intrapericardial mass, occuping a large portion of anterior and mid part of the left mediastinum as well as liver haemangioma. Diagnostic coronarography demonstrated partial arterial blood supply to the malformation was coming from diagonal branch of the left anterior descending artery. With all these imaging characteristics of the mass, we reached a diagnosis of capillary hemangioma with rapid blood flow. Due to the asymptomatic nature of the mass and high risk of complex and potentially hazardous excision, the team decided for close follow-up. At 6 months follow-up, the patient remains asymptomatic and the mass shows no signs of progression. Due to their rarity, and oftentimes incidental finding, population-based data for pericardial hemangiomas are limited. Surgical resection is treatment of choice, but it is not always necessary. Multimodality imaging is the cornerstone of diagnosing mediastinal masses – hence the need for continuous education in the field to recognize rare pathology.  Further research is necessary to better understand their pathogenesis and optimal management strategies. In-depth knowledge and experience in all imaging modalities as well as close collaboration between different specialties saves lives by refraining from potentially detrimental procedures.