a 74-year - old man presented with mild dyspnea and chest discomfort for 30 months .
trans - thoracic echocardiographic findings showed a left atrial echogenic mass ( 21.5 cm ) ( fig .
1 ) . a provisional diagnosis of a left atrial ( la ) myxoma was made , and the patient was admitted for the surgical excision of the tumor .
coronary angiography revealed a 50% stenosis on the mid - portion of the left anterior descending artery ( lad ) .
we planned the concomitant operation with mass excision and coronary artery bypass . under general anesthesia with supine position ,
conventional cannulation was performed , and the right atrial wall and the interatrial septum were incised .
further , we anastomosed the left internal thoracic artery to the distal portion of the lad .
the resected mass was oval and was made of a white jelly - like material .
we resected the mass including the myocardium , and the la wall was closed by a prolene suture .
hemangioma of the heart presenting as a primary cardiac tumor is extremely rare ; it accounts for approximately 2.8% of all primary resected heart tumors .
its histological subtypes are as follows : 1 ) cavernous hemangioma , 2 ) capillary hemangioma , and 3 ) arteriovenous hemangioma or cirsoid aneurysm .
the capillary hemangioma has lobules of endothelial cells forming small , capillary - like vessels .
the arteriovenous hemangioma consists of dysplastic thick - walled arterioles , venous - like vessels , and capillaries . in our case ,
the tumor is a capillary hemangioma that shows ill - defined aggregates of closely packed , thin - walled capillaries filled with blood cells ( fig .
further , tumors may be located in any heart chamber , the pericardium , the endocardium , or the myocardium .
, and the localization of cardiac hemangiomas was the right ventricle in 20 cases ( 35.7% ) , the left ventricle in 19 cases ( 33.9% ) , the right atrium in 13 cases ( 23.2% ) , the interatrial septum in 6 cases ( 10.7% ) , the interventricular septum in 6 cases ( 10.7% ) , and the left atrium in 4 cases ( 7.1% ) .
very few cases of cardiac hemangiomas have been reported to be arising from the la wall , mimicking the classic presentation of a myxoma . in our patient , the tumor was located in the orifice of the right lower pulmonary vein . however , venous flow obstruction was not observed .
some cardiac hemangiomas are asymptomatic and are discovered during cardiac surgery or upon autopsy . in symptomatic patients , cardiac hemangiomas
cause arrhythmia , pericardial effusion , congestive heart failure , right ventricular outflow tract obstruction , coronary insufficiency , and sudden death .
diagnosis can be made by echocardiography , computed tomography ( ct ) , or magnetic resonance imaging ( mri ) .
coronary angiography is sometimes useful in revealing how the tumor is fed and its characteristic tumor blush .
however , we can not find any feeding vessel or tumor blush in preoperative coronary angiography . in the opinion of a cardiologist , the tumor had a myxoma - like shape and exhibited echogenicity .
atrial hemangiomas , particularly those attached to the la wall , may be erroneously diagnosed as myxomas . however , there are no myxoma cells or lepidic cells that can be found usually in cardiac myxomas , and cellular areas with numerous capillaries are usually present .
patients with a resectable tumor usually have a good prognosis , but those with an unresectable tumor may have a poor prognosis because of ventricular tachycardia , sudden death , local progression , or systemic dissemination of the malignant tumor .
therefore , we believe that if surgical resection is possible , surgery is the best way to treat cardiac hemangioma .
cardiac hemangioma is a rare disease ; furthermore , a tumor arising from the la wall and misconceived as a myxoma is extremely rare .
we removed the mass misdiagnosed as a myxoma and pathologically confirmed it to be a cardiac capillary hemangioma . in order to share our experience
 hemangioma of the heart , presenting as a primary cardiac tumor is extremely rare ; it accounts for approximately 2% of all primary resected heart tumors . in our patient , 
 the tumor was located in the orifice of the right lower pulmonary vein . 
 few cases of cardiac hemangiomas have been reported to arise from the left atrial ( la ) wall . left atrial hemangiomas , especially those attached to the la wall , may be erroneously diagnosed as myxomas . 
 cardiac hemangioma is a rare disease ; furthermore , a tumor arising from the la wall and misconceived as a myxoma is extremely rare . 
 we removed a mass misdiagnosed as a myxoma ; it was pathologically confirmed to be a cardiac capillary hemangioma . 
 therefore , we report a rare case of a cardiac hemangioma misconceived as a myxoma ; the tumor was removed successfully . 
CASE REPORT
DISCUSSION