Pericardial Hemangioma: An 8-Year Diagnostic Odyssey of Recurrent Pleural Effusion

Pericardial hemangioma is a rare benign tumor that can mimic chronic inflammatory disease. Distinguishing it from other pericardial masses is critical to avoiding a diagnostic delay.

A 54-year-old woman presented with an 8-year history of recurrent effusions and was initially thought to have amyloidosis. Cardiac magnetic resonance (CMR) imaging identified a transverse pericardial sinus mass with characteristic T2 hyperintensity and centripetal enhancement, strongly suggesting hemangioma, which was confirmed histologically. Surgical excision was curative, with no recurrence at the 4-year follow-up.

This case illustrates the "satisfaction of search" bias causing an 8-year diagnostic delay. It highlights the central role of comprehensive CMR tissue characterization in evaluating rare pericardial tumors, and the risk of anchoring on potentially misleading histopathological findings.

Pericardial hemangioma should be considered in unexplained recurrent effusions, particularly when corticosteroid therapy paradoxically reduces fluid volume and extensive autoimmune and oncologic work-up is unrevealing. Comprehensive CMR with tissue characterization is the key noninvasive modality, although histology remains confirmatory. A prior pericardial window may convert episodic pericardial effusion into chronic, treatment-refractory pleural disease by creating a preferential drainage pathway into the left pleural space.