Left atrial hemangioma presenting as cardiac tamponade.

A 43-year-old man presented at the emergency department with weakness and dyspnea. He was hypotensive and hypothermic. Physical examination revealed prominent jugular venous distention, muffled heart sounds, and a palpable pulsus paradoxus. Transthoracic echocardiography confirmed the presence of a concentric pericardial effusion that was causing tamponade (Fig. 1). Emergency pericardiocentesis resulted in the drainage of 500 cc of bloody effusion. Hemodynamic stability ensued. Fig. 1 Transthoracic echocardiography (parasternal long-axis view) shows a mass in the left atrium. Ao = aorta; E = pericardial effusion; LA = left atrium; LV = left ventricle; T = tumor Echocardiography after the procedure showed resolution of the pericardial effusion and revealed a 4-cm left atrial mass. Computed tomography (CT) showed a heterogeneously contrast-enhanced soft-tissue density in the right atrium (Fig. 2). Subsequent cardiac magnetic resonance imaging (MRI) showed a right atrial mass arising from the atrial septum and exerting pressure on the left atrium (Fig. 3). Fig. 2 Contrast-enhanced axial computed tomographic scan shows a soft-tissue mass (8.6 × 4 × 7 cm) that extends rightward from the left atrium and compresses the right atrium. Ao = aorta; LA = left atrium; RAA = ... Fig. 3 Axial image through the heart, using double inversion recovery (T1-weighted) magnetic resonance imaging, shows a large soft-tissue mass, appearing to be in the right atrium and exerting mass effect on the left atrium without evidence of invasion. ... After median sternotomy, a large, firm mass was found in the left atrium. The mass involved the atrial septum, distorted the dome of the left atrium superiorly and anteriorly, and extended between the aorta and the right atrium (Fig. 4). Analysis offrozen sections from a transseptal biopsy provided no immediate diagnosis. Whenfinal results of pathologic studies revealed a cavernous hemangioma, the patient underwent resection of the mass, the dome of the left atrium, and almost the entire atrial septum. The dome and the septum were reconstructed with bovine pericardium. The patient was discharged from the hospital on postoperative day 3. A postoperative echocardiogram was normal. Fig. 4 Intraoperative photograph reveals a large left atrial mass that displaces the normal right atrium laterally. Ao = aorta; RAA = right atrial appendage; T = tumor