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).