Manuscript
Primary cardiac tumors are rare, with a post mortem incidence of
0.001%-0.028%. (1) Imaging techniques play an important role in
detection and differential diagnosis of cardiac masses.
We report a 43-year-old male presented to the Emergency Room with
palpitations and atypical chest pain following emotional stress. Prior
to this event he had never had any similar symptoms. Clinical
examination, ECG and chest x-ray were unremarkable. Serial biomarkers
were negative. Trans-thoracic echocardiography (figures 1) showed a
well-defined, large left ventricular mass at the anterolateral papillary
muscle, attached to the infero-lateral wall without invading it, there
was a clear multiple chordae insertion into the mass, with no
obstruction, or mitral valve dysfunction and no pericardial effusion.
Cardiac computed tomography scan with contrast (figures 2) showed
heterogenous contrast enhancement of a well circumscribed and clearly
defined smoothly outlined mass. Cardiac magnetic resonance imaging
(figures 3) showed high signal intensity, and early heterogeneous
enhancement hyperintense on T2, with regional variations in vascularity,
as well as delayed late gadolinium enhancement.
Pan CT scan (brain, chest, and abdomen) showing no extra-cardiac
abnormalities. Coronary angiography showing normal coronaries. The mass
was surgically removed and the mitral valve was repaired. The
histopathological specimen (figure 4) revealed hypertrophic cardiac
myocytes, cells were lying in a disordered pattern, mixed with vascular
and fibrous tissues, and the final histopathology diagnosis was
non-neoplastic tumor, cardiac hamartoma (2).