Malignant Presentation of Cardiac Hemangioma

A 46-year-old woman suffered effort intolerance for months. She had been healthy in the past, without systemic diseases. She had experienced near-syncope before arrival at our center. On admission, her physical examination was unremarkable. ECG exhibited normal sinus rhythm, P pulmonale, and first-degree atrioventricular (AV) block. A transthoracic echocardiogram demonstrated a huge right atrial (RA) mass, 7.98×5.70 cm in size, with 23 mm Hg of transvalvular pressure gradient. The global ventricular contractility was normal (Data Supplement Movies I and II). These findings were confirmed by 3-dimensional echocardiography (Figure 1; Data Supplement Movies III and IV). Cardiac magnetic resonance imaging showed a large, well-defined intracavity mass on T1-weighted image. After contrast injection, delayed images revealed a strong signal indicating hypervascularity (Figure 2 and online-only Data Supplement), highly suggestive …