A rare presentation of pericardial cavernous hemangioma: case report

Pericardial hemangiomas are exceedingly rare benign vascular cardiac tumors that may remain asymptomatic for years but can cause compression, arrhythmia, effusion, or heart failure when large. Early recognition and definitive management are important to avoid morbidity.

A 56-year-old woman with well-controlled hypertension and diabetes presented with two months of progressive retrosternal chest heaviness and dyspnea. She reported a known intrapericardial mass monitored for 10 years. CT angiography revealed a well-circumscribed, vascularized intrapericardial mass (5.5 × 6.2 × 4.0 cm) compressing the left atrium with a central hypodense area; transthoracic echocardiography showed preserved left ventricular function (EF 60%). The patient underwent median sternotomy and complete surgical excision; intraoperative dissection identified vascular supply from the left circumflex artery. Histopathology confirmed a cavernous hemangioma (resected specimen 7.5 × 4.5 × 3.0 cm). The postoperative course was uneventful and she was discharged on postoperative day 4.

Although uncommon, pericardial hemangiomas should be considered when imaging demonstrates vascular cardiac masses. Multimodality imaging aids planning; symptomatic lesions are best managed by complete surgical resection to relieve compression and prevent complications.

This case illustrates successful surgical management of a symptomatic pericardial cavernous hemangioma and highlight the value of timely diagnosis and resection for optimal outcomes.