Rare Presentation of Asymptomatic Pericardial Effusion
Hemangioma of the Atrioventricular Groove in Cardiac Magnetic Resonance Imaging
Cardiac hemangiomas are rare vascular tumors that account for 2% to 5% of benign cardiac masses. They are constituted by endothelial cells lining vascular channels, and they can be histologically classified into capillary, cavernous, or arteriovenous hemangiomas. They may affect the endocardium, myocardium, and epicardium of the ventricles, atria, valves, and, rarely, the pericardium.1 The natural history of pericardial hemangiomas is difficult to predict, and its course may be complicated by asymptomatic pericardial effusion or by recurrent pericardial tamponade.2,3 Here, we describe 3 patients with a very rare clinical condition, pericardial hemangioma presenting with pericardial effusion and diagnosed by cardiac magnetic resonance (CMR).
The first patient was a 75-year-old man with a history of hypertension who was complaining of worsening dyspnea. Echocardiography showed an incidental pericardial effusion and a hyperechogenic mass located in the atrioventricular groove. CMR (Figure 1 and Movies I and II in the online-only Data Supplement) confirmed the presence of a mobile, polilobated mass adherent to the atrioventricular groove, which grew like an extracardiac mass in the pericardial space, surrounded by moderate pericardial effusion without tamponade. T1-weighted fast-spin-echo images showed a hyperintense border surrounding a hypointense core, whereas T2-weighted short-time inversion-recovery images disclosed a hypointense border surrounding a hyperintense core, and …