Cardiac Hemangioma Mimicking Infective Endocarditis

Abstract

Cardiac hemangiomas are rare and often misdiagnosed due to their nonspecific clinical presentations. We report a case of a 70-year-old man presenting with chills and cold sweats, initially suspected of having infective endocarditis based on echocardiographic findings of a mobile mass on the mitral valve. Laboratory results showed leukocytosis and elevated C-reactive protein, but blood cultures were negative. Transesophageal echocardiography later revealed a well-defined mass with characteristics suggestive of a tumor. Surgical excision confirmed the diagnosis of hemangioma. Postoperative recovery was uneventful, with no mitral regurgitation. This case highlights the importance of considering cardiac tumors in the differential diagnosis of intracardiac masses.

Cardiac hemangiomas are rare cardiac tumors usually described in case reports [1]. Cardiac hemangiomas usually lack significant clinical manifestations unless cardiac compression or obstruction occurs [2]. Herein, we present a case of cardiac hemangioma initially misdiagnosed as infective endocarditis based on the imaging and clinical presentation.

A 70-year-old man presenting with chills and cold sweats was transferred to the emergency room. An echocardiogram revealed a mobile 1.57 × 2.47 cm mass on the mitral valve (Figure 1A,B); consequently, vegetation was suspected (details in Supplementary Table S1). The laboratory tests revealed leukocytosis, elevated C-reactive protein levels, and negative blood culture (details in Supplementary Table S2). However, the echocardiologist questioned the diagnosis because of the mass’s smooth, well-defined shape (differential diagnosis in Supplementary Table S3). Transesophageal echocardiography identified a 1.9 × 1.4 cm polypoid mass with a pedicle attached to the annulus near P2, suggesting a tumor (Figure 1C,D). During surgery, a round 1.5 × 1.5 × 1.5 cm tumor was identified at the mitral annulus between P1 and P2 that was connected to underlying mitral annulus calcification (Figure 2A,B). The tumor and a small part of the annulus endocardium were excised, and a mitral ring annuloplasty was performed. Pathology confirmed the diagnosis of hemangioma with dense lymphocyte infiltrate (Figure 2C,D). Postoperative echocardiography revealed no mitral regurgitation. Previous reports have mentioned that hemangiomas on the mitral valve may cause multiple brain infarcts [3]. Other types of intracardiac tumors, such as cardiac papillary fibroelastoma, have also been misdiagnosed as infective endocarditis [4]. Through this case, we hope to offer clinicians with additional perspectives for the diagnosis and management of intracardiac mass lesions.