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.