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Myocardial haemangioma: echocardiographic, MRI, and anatomical correlation

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A 44 year old woman presented with intermittent atypical chest pain and epigastric discomfort of three months' duration. An ECG revealed anterior T wave inversion (leads V2–V6). A chest radiograph was normal. Transthoracic echocardiography revealed a mass in the distal inferoposterior wall of the left ventricle. A transoesophageal echocardiogram was performed. This confirmed a well defined mass measuring 4.0 × 3.5 cm with a heterogenous echotexture and apparent small cystic cavities in the distal posteroinferior wall of the left ventricle. There was no evidence of pericardial involvement. Magnetic resonance imaging (MRI) revealed a well defined, solid 4.8 × 4.3 cm mass arising from the apical posteroinferior left ventricular myocardium, with a mildly heterogenous signal on T1, a very bright signal on STIR, and pronounced contrast enhancement (left). This was felt to be a benign vascular tumour such as a haemangioma. A blood screen, including hydatid serology, and an abdominal ultrasound scan were normal.

A transarterial biopsy was considered but as the tumour did not extend to the endocardium and there was no infiltration into the pericardium, the decision was made to perform a complete excision biopsy with cardiopulmonary bypass. The surgical specimen measured 5.1 × 3.6 cm, and had the appearances of a benign haemangioma (right) which was confirmed on subsequent histology. It was completely excised and the myocardium sutured without the need for a patch. The base of the posterior papillary muscle required reinforcement with pledgetted ticron sutures. A postoperative transthoracic echocardiogram showed good left ventricular function with only mild mitral regurgitation. The patient made an uneventful recovery and was discharged from hospital on the sixth postoperative day.

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