Case presentation
A 56-year-old female was admitted to hospital with chest pain and breathlessness following percutaneous drainage of pericardial effusion. Repeat echocardiography demonstrated effusion recurrence. A pericardial window was created through left video assisted thorascocopy that drained 500ml of straw coloured fluid with no evidence of purulence or malignancy.
On follow-up computed tomography (CT) of the chest and dedicated CT coronary angiography (Figure 1A) a 2 cm extracardiac lesion was identified adjacent to the pulmonary trunk suggestive of vascular malformation. Cardiac magnentic resonance confirmed a 22 x 28 x 29 mm mass (Figure 1B) to the left side of the pulmonary trunk with no evidence of invasion into the myocardium or other cardiac structures. The lesion was positron emission tomography negative.
The decision for surgical excision was made in a multidisciplinary setting, due to diagnostic uncertainty and possibility of low-grade sarcoma. Through median sternotomy and release of dense pericardial adhesions, a 2.5 cm rounded para-pulmonary artery mass was excised en-block with part of the PA adventitia (Figure 2A and 2B). A small feeding vessel taking origin from the vasa vasora of the pulmonary trunk was ligated. Histopathology confirmed capillary haemangioma and no evidence of malignancy. Postoperative course was short and uneventful.