SCMR 22nd Annual Scientific Sessions
Description of Clinical Presentation:
11-year-old healthy male patient presented to his pediatrician with cough. A chest radiograph was ordered demonstrating enlargement of the cardiac silhouette. After referral to a pediatric cardiologist, echocardiogram was ordered demonstrating left ventricular hypertrophy along the lateral and inferior walls. An electrocardiogram demonstrated inverted T waves in the lateral leads. A cardiac MRI was ordered for evaluation of Hypertrophic Cardiomyopathy.
Diagnostic Techniques and Their Most Important Findings:
Cardiac MR performed on a 3T GE Signa Architect magnet acquiring multiplanar SSFP, short axis T1/T2 double IR, multiphasic MRA, 4D Flow, and delayed enhancement utilizing intravenous Gadobutrol. The images demonstrate a large, T1 hyperintense, T2 hyperintense infiltrative mass centered along the lateral wall of the left ventricle extending to the inferior wall. The mass lesion demonstrates early peripheral arterial enhancement, homogeneous enhancement on the venous phase, and avid persistent enhancement on delayed phases of imaging. Given the infiltrative, vascular nature of the tumor, the differential diagnosis includes both benign and malignant cardiac neoplasms. No additional metastatic disease or lymphadenopathy was identified. Open biopsy was performed via median sternotomy with a pathologic diagnosis of cavernous hemangioma.
Learning Points from this Case:
Cavernous hemangioma is a rare primary cardiac tumor accounting for less than 3% of cardiac neoplasms. Cardiac hemangiomas can arise in a variety of locations in the heart, most commonly in the ventricles with a variety of appearances. Lesions are most commonly pedunculated but can be infiltrative as seen in this case. Cardiac MRI is an excellent imaging modality to evaluate tumor margination, degree of involvement, and associated findings. Cardiac hemangioma is a vascular tumor with similar imaging characteristics as other vascular tumors such as angiosarcoma, rhabdomyosarcoma, or paraganglioma. However, given the age and clinical presentation, these were felt to be less likely.
In the pediatric population, cardiac hemangioma is most commonly incidentally diagnosed. Surgical removal is the recommended treatment of choice; however, in this case, given the infiltrative nature, the lesion is not amenable to surgical removal. Therefore, conservative management is recommended unless ventricular arrhythmia or pericardial effusion develops, at which time the patient will be considered for heart transplantation.