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A connective tissue pericardial hamartoma: A case report with literature review of cardiac hamartoma.

ABSTRACT:

Introduction

Hamartoma is a tumor that can manifest anywhere in the body and results in the abnormal formation of tissue native to the anatomical location. It is usually a benign tumor that rarely arises from the heart or pericardium. Most of the cases are asymptomatic and discovered incidentally during the evaluation of other medical conditions.

Presentation of case

We present a case of a 65-year-old female with dyspnea who was diagnosed with a mediastinal mass. After removing the mass surgically, the mass was found to be heart-like containing four chambers located in the pericardium, and a pathology report of a connective tissue hamartoma.

Conclusion

Pericardial tumors including hamartoma should be considered in all patients with wide mediastinum and cardiopulmonary symptoms. We also present a review of the literature on the cardiac and pericardial hamartomas with a comparison of age, gender, location, symptoms, and management. Although cardiac hamartomas in general and epicardial hamartomas, in particular, are extremely rare, they should be considered in adults with cardiopulmonary symptoms and widened mediastinum.

SUBMITTER: Al Houri HN

PROVIDER: S-EPMC9240792 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionPericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent approximately 6% of all mediastinal masses. Patients can present with symptoms similar to acute chest pain or right-sided heart failure or can be asymptomatic.PresentationA 46-year-old female who is known to have hypertension and hypothyroidism presented to the breast clinic with left breast mass that was proved by core needle biopsy as proliferative breast lesion. During the preoperative assessment, the patient reported progressive shortness of breath and cough over the last two years and bilateral lower limb edema. Her preoperative chest X-ray showed a well-defined oval like opacification at the right cardiophrenic angle that was proved by chest computed tomography imaging as a cystic mass od most likely a pericardial origin. A huge pericardial cyst originating from the right diaphragmatic surface was excised through a mini-sternotomy incision with smooth postoperative recovery. The patient-reported significant improvement in her symptoms and her lifestyle during her follow up.DiscussionPericardial cysts represent 6%-7% of all mediastinal masses with an estimated incidence of 1:100,000. About 70% of pericardial cysts originate at the right cardiophrenic angle and less frequently at the left cardiophrenic angle, they are usually suspected when the chest x-ray shows an enlarged contour of the right heart border. Mediastinal cysts have many differential diagnoses and the preoperative decision might be challenging in many cases. Pericardial cysts appear as oval, thin-walled homogeneous masses on cardiac computed tomography. The choice between surgical intervention and conservative follow up is related mainly to the size and symptoms that are induced by the cyst.ConclusionAs pericardial cysts are rarely diagnosed pathology, a high index of suspicion is essential for diagnosis. Surgical resection is indicated when they are huge, enlarging in size or symptomatic. Morbidity and mortality risks following pericardial cyst excision are very low.