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(Circulation. 1999;100:564-565.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Epithelioid Hemangioendothelioma of the Thoracic Aorta Resulting in Aortic Obstruction and Congestive Heart Failure

Jay H. Traverse, MD; John R. Lesser, MD; Bjorn P. Flygenring, MD; Thomas H. Bracken, MD; Olga M. Olevsky, MD; Demetre M. Nicoloff, MD; Thomas Flavin, MD; Charles A. Horwitz, MD; Robert G. Hauser, MD

From the Minneapolis Heart Institute at Abbott Northwestern Hospital (J.H.T., J.R.L., B.P.F., D.M.N., T.F., R.G.H.), the Department of Internal Medicine (O.M.O.), the Department of Pathology (C.A.H.), and the Cardiovascular Division (J.H.T.), University of Minnesota Medical School, Minneapolis, and Mille Lacs Health System, Onamia, Minn (T.H.B.).

Correspondence to Jay H. Traverse, MD, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis Cardiology Associates, 920 E 28th St, Suite 300, Minneapolis, MN 55407. E-mail trave004@tc.umn.edu

	Introduction

 
A54-year-old white woman was referred for cardiac consultation because of increased dyspnea with exertion and leg pain. The patient's past medical history was significant for smoking and recent onset of hypertension. On physical examination, she was found to have a blood pressure of 180/90 mm Hg and a heart rate of 110 bpm. The lungs were clear to auscultation. The carotid upstrokes were bounding, and there were bilateral carotid bruits. The central venous pressure was not elevated. The cardiac examination was significant for a loud, harsh systolic murmur (II to III/VI) across the precordium with radiation to the back. There was a left ventricular lift and a third heart sound. The abdominal examination was normal, and stool guaiac was negative. There was no peripheral edema. The femoral pulses were diminished.

The ECG showed normal sinus rhythm, left atrial enlargement, incomplete right bundle-branch block, and voltage and T-wave changes suggestive of left ventricular hypertrophy. An echocardiogram showed a global decrease in left ventricular function, with an ejection fraction of 25%. There was mild left ventricular hypertrophy and mild mitral regurgitation. The chest radiograph showed moderate cardiomegaly with clear lung fields and normal pulmonary vasculature. Significant laboratory findings included a hemoglobin of 10.1 (mean corpuscular volume=90) and an elevated calcium of 11.6. The patient was referred for bilateral heart catheterization and coronary angiography.

At angiography, her femoral pulses were diminished. A guidewire could not be passed beyond the thoracic aorta; therefore, angiography was performed with a left brachial approach. The proximal aortic . . . [Full Text of this Article]

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