Rare presentation of asymptomatic pericardial effusion: hemangioma of the atrioventricular groove in cardiac magnetic resonance imaging.

C ardiac hemangiomas are rare vascular tumors that account for 2% to 5% of benign cardiac masses. They are constituted by endothelial cells lining vascular channels, and they can be histologically classified into capillary, cavernous, or arteriovenous hemangiomas. They may affect the endocar-1 The natural history of pericardial hemangiomas is difficult to predict, and its course may be complicated by asymptomatic pericardial effusion or by recurrent pericardial tamponade. 2,3 Here, we describe 3 patients with a very rare clinical condition, pericardial heman-gioma presenting with pericardial effusion and diagnosed by cardiac magnetic resonance (CMR). The first patient was a 75-year-old man with a history of hypertension who was complaining of worsening dyspnea. Echocardiography showed an incidental pericardial effusion and a hyperechogenic mass located in the atrioventricular groove. CMR (Figure 1 and Movies I and II in the online-only Data Supplement) confirmed the presence of a mobile, poli-lobated mass adherent to the atrioventricular groove, which grew like an extracardiac mass in the pericardial space, surrounded by moderate pericardial effusion without tamponade. T1-weighted fast-spin-echo images showed a hyperintense border surrounding a hypointense core, whereas T2-weighted short-time inversion-recovery images disclosed a hypointense border surrounding a hyperintense core, and gadolinium-first-pass and late-enhancement imaging showed a central, hyperintense core. All these characteristics seemed typical of pericardial hemangioma of the atrioventricular groove consisting of a vascular core surrounded by pericardial fat. Coronary angiography confirmed the diagnosis, showing the presence of a vascular tangle perfused by the left circumflex artery. The second patient was a 73-year-old asymptomatic woman with a history of chronic renal failure who was admitted because of a new-onset pleuro-pericardial effusion. Echocardiography confirmed the severe pericardial effusion, initially referred to her chronic renal failure, with partial atrial collapse. She underwent a CMR scan to better characterize the effusion (Figure 2 and Movie III in the online-only Data Supplement). Cine images showed the presence of 2 pedunculated, partially mobile masses within the large peri-cardial effusion located in the right and left atrioventricular groove, close to the right and circumflex coronary arteries. As in the previous case, the masses appeared heterogeneously hypo-isointense on T1-weighted fast-spin-echo images and hyperintense in T2-weighted images. Even though the patient was not given any gadolinium contrast agent because of the severe renal failure, all these findings suggested the diagnosis of double pericardial hemangioma of the atrioventricular groove. The third patient was an 86-year-old woman hospitalized for dyspnea, peripheral edema, and palpitations. Echocardiography …