Cavernous hemangioma of the right atrium.

A 42-year-old woman was diagnosed during the 3rd month of pregnancy with a large right atrial tumor. Three weeks after successful completion of a full-term pregnancy, she was admitted and underwent surgical removal of the tumor. Postoperative course was uneventful and pathology showed cavernous hemangioma. These neoplasms should be removed in order to prevent severe arrhythmias as also potential malignant transformation.

Question: What is the appropriate approach to this pathology in the setting of a pregnancy?

Answer: Surgical resection is recommended to prevent consequences of complicating atrial fibrillation and neutralize the risk of transformation to angiosarcoma. Due to slow tumor growth, it appears safe to await completion of pregnancy before surgical intervention.

Case History

A 42‐year‐old female patient during routine checkup at her 3rd month of pregnancy was found with an echogenic mass within the right ventricle following complaints of palpitations (Fig. 1). Her medical history included a lipoma resection from the right breast as also a suprasellar tumor for which she underwent subtotal resection and adjuvant gamma knife radiosurgery. Echocardiography demonstrated normal dimensions of left and right ventricles while the right atrium was occupied by a 4.4 × 5 cm mass (Fig. 1A). Magnetic resonance imaging confirmed the findings (Fig. 1B). Three weeks after giving birth to a healthy 3.7 kg baby, she was admitted to our department and underwent an elective surgical procedure on cardiopulmonary bypass and cardioplegic cardiac arrest (Fig. 2A). The tumor, encapsulated by an intact brownish outer membrane, strongly attached to the atrium was completely removed with a segment of the atrial wall (Fig. 2B). The latter was restored utilizing a bovine pericardial patch. Postoperative course was uneventful. Pathology showed cavernous hemangioma (Fig. 2C and D).

Figure 1

(A) Echocardiography (four‐chamber view) depicting the mass (arrows) in the right atrium (RA). (B) Magnetic resonance imaging illustrating the rounded mass (arrows) attached to the right atrial free wall. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 2

(A) Operative view: large tumor (white large arrows) occupying a substantial part of the right atrium (black small arrows). (B) Specimen. (C) Histopathology showing a vascular tumor (hematoxylin and eosin, 100x). (D) CD31 monoclonal antibody for endothelial cells (100x) reveals cavernous hemangioma. TV, tricuspid valve.

Cavernous hemangiomas develop in either gender and at any age. Symptoms depend on their anatomical location within the heart and the resultant hemodynamic consequences 1. Echocardiography remains a reliable diagnostic tool supplemented by computerized tomography and magnetic resonance imaging. Due to the known hormonal influence on tumor size, the patient was thereafter closely followed by echocardiography alone 1, 2. Complete surgical resection is the treatment of choice to prevent hemodynamic complications and potential malignant transformation. Prognosis is good, although recurrences have been reported 1, 3.

Conflict of Interest

None declared.