Pericardial Hemangioma: A Case Report and Updated Literature Review

Pericardial hemangiomas are rare benign tumors that may present with variable symptoms and mimic other cardiac masses. Awareness of this entity and an organized diagnostic approach are critical.

A 57-year-old man presented with positional chest pain. Coronary computed tomography angiography demonstrated a hypervascular pericardial mass. Cardiac magnetic resonance characterized the lesion as an epicardial tumor contiguous with the visceral pericardium, with suspicion for an intrapericardial paraganglioma. However, DOTATATE positron emission tomography/computed tomography and plasma catecholamines were normal. The patient underwent surgical excision, and histopathology analysis confirmed pericardial hemangioma. He was without recurrence at the 3-month follow-up.

This case illustrates the diagnostic discordance between computed tomography and cardiac magnetic resonance in evaluating hypervascular pericardial masses and underscores the need for multimodal imaging, functional testing, and histopathological confirmation.

Pericardial masses with persisting diagnostic ambiguity after noninvasive imaging should prompt surgical resection for definitive diagnosis and treatment. Early surgical resection yields excellent outcomes, with cardiologists playing an essential role in recognizing the condition, guiding diagnostic work-up, and managing perioperative care.