Case of Cardiac Hemangioma Diagnosed by Myocardial Contrast Echocardiography.

May 2019 1 Qin Xiachuan, MD Liu Xuebin, MD Wang Yongjie, MD A 51-year-old woman presented with an 8-month history of exertional chest pain. Her chest X-ray and coronary artery computer tomography angiography were unremarkable. The results of an ECG were normal. Transthoracic echocardiography showed that the right ventricular outflow tract had a hypoecho mass, wide base, regular shape, clear boundary, and slight activity with the cardiac cycle(Figure 1A; Movie I in the Data Supplement). The peak flow velocity of the right ventricular outflow tract was 1.8 m/s. A myocardial contrast echocardiogram was then performed. After several cardiac cycles, the tumors showed peripheral nodular enhancement (Figure 1B and 1C). Furthermore, they were in continuous partial centripetal filling. Finally, the nodule was hyperenhancing in the periphery; however, the central area was hypoenhancing (Figure 1D; Movie II in the Data Supplement). Cardiac magnetic resonance imaging with gadolinium contrast showed equal and slightly high signal on T1 weighted imaging, similar to the myocardial signal; the T2 weighted imaging showed a substantial high signal (Figure 2A), with perfusion sequence in the low perfusion defect area, and the delayed enhancement lesion was substantially enhanced (Figure 2B). The patient underwent cardiac tumor resection. The excised specimen was 2.0×2.0×1.8 cm (Figure 3A). The soft tissue was gray and dark red. The base was wider, with a complete envelope. Microscopic examination of hematoxylin-eosin-stained sections revealed tissue involved with neovessels of variable sizes containing blood, with no cytological atypia of endothelial cells or necrosis. Postoperative histopathologic diagnosis was cardiac capillary hemangioma (Figure 3B). Cardiac hemangioma constitutes only 2.8% of primary cardiac neoplasms.1 Most cardiac hemangiomas arise from the left ventricle and the right atrium, while right ventricular hemangiomain the outflow tract is rare.2 Echocardiography can accurately diagnose and display the location and size of tumors and can clarify the impact of their relationship with myocardium, valves, and hemodynamics. Contrast-enhanced myocardial echocardiography has developed quickly in recent years and been gradually applied to the diagnosis of myocardial and cardiac tumors. There have been no reports of contrast-enhanced echocardiography of cardiac hemangiomas, to date, although many studies have discussed hepatic hemangiomas.3 Similarly, peripheral nodular and centripetal enhancement have also appeared in the cardiac hemangiomas. Finally, the nodule is hyperenhancing in the periphery; however, the central area as hypoenhancing. This difference may be related to thrombosis in hemangioma. Peripheral nodular and centripetal enhancement might be valuable for the characterization of cardiac hemangiomas, and further study is needed. © 2019 American Heart Association, Inc. CARDIOVASCULAR IMAGES