A Rare Case of Cardiomegaly
Dr. Hasan Ali Jilaihawi, BSc (Hons), MBChB, MRCP, Steven J Leslie and Allister D. Hargreaves
Falkirk and District Royal Infirmary, Falkirk, UK.
A previously well 66 year old lady presented to our Cardiology clinic with a 1 month history of progressive shortness of breath on exertion. Her primary care physician performed a chest radiograph which was reported as "global cardiac enlargement and a prominence over the pulmonary area and the left atrial appendage"(Figure A). She had a fourth heart sound and a soft systolic murmur audible over the pulmonary area but cardiovascular examination was otherwise normal, as was her electrocardiogram. Echocardiogram was performed (Figure B). This revealed good left ventricular function but showed a large mass (H) which encased the aorta and pulmonary artery and extended down across the anterior aspect of the heart to compress both right atrium and right ventricle. This was 10cm across and was associated with some pericardial fluid (Eff). The findings were confirmed on magnetic resonance scanning. Thoracoscopy was performed and 150mls dark serous fluid evacuated from the pericardial sac. The mass seen on echocardiography was noted to be vascular in appearance and entirely intrapericardial. Several samples were sent for biopsy without causing haemorrhage. A magnetic resonance scan after surgery is shown (Figure C). Histological appearances of the mass were of a benign vascular haemangioma (Figure D) with dilated capillary and venous elements and some surrounding smooth muscle. Some 2 years after drainage of her pericardial effusion she has remained largely asymptomatic and the mass unchanged. She is being followed up with regular magnetic resonance scanning.
Figure legend
A Chest Radiograph. B Echocardiogram; a modified parasternal long axis view is shown with left (LV) and right ventricle (RV), pericardial effusion (Eff) and haemangioma (H) labelled). C Magnetic Resonance scan post surgery. D Micrograph of pericardial biopsy; approximate magnification x40.
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