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.
Supplementary Materials
The following supporting information can be downloaded at
https://www.mdpi.com/article/10.3390/diagnostics14192109/s1. Supplementary Table S1. Details of patient’s echocardiography. Supplementary Table S2. Details of patient’s laboratory data. Supplementary Table S3. Differential diagnosis of the intracardiac mass in this case. Video S1. Parasternal long-axis transthoracic echocardiography view showing a mobile mass on the posterior leaflet of the mitral valve. Video S2. Transesophageal echocardiography showing a 1.9 × 1.4 cm polypoid mass with a pedicle attached to the annulus near the P2 segment, partially protruding into the left ventricle during diastole. Video S3. Transesophageal echocardiography color Doppler showing a mild mitral regurgitation jet. Grading of mitral regurgitation may have been underestimated due to the mitral mass obstacle. Video S4. Coronary angiography for left anterior descending artery. Video S5. Coronary angiography for left circumflex artery. Video S6. Coronary angiography for right coronary artery.
Author Contributions
Conceptualization, C.-M.Y.; Data curation, C.-M.Y.; Project administration, Y.-N.H.; Supervision, Y.-N.H.; Validation, Y.-N.H.; Writing—original draft, C.-M.Y.; Writing—review and editing, Y.-N.H. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The institution IRB approved this study (A-EC-113-019, 8 July 2024, National Cheng Kung University Hospital).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s) to publish this paper.
Data Availability Statement
The data are available on request from the authors.
Conflicts of Interest
The authors declare no conflicts of interest.
References
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