PMC3104538_01
(a) Volume-rendered MSCT image showing the site of the lesion centered on the AV groove, splaying the right atrium (RA) and right ventricle (RV) and slightly compressing them and the origin of the main pulmonary artery (PA). It also demonstrates the right coronary artery (RCA) originating from the aorta (AO) and passing into the site of the lesion without alteration of its course. (b) MSCT image of the heart in the axial plane after contrast administration showing the partially heterogenous hypodense lesion (L) involving the anterior mediastinal region, splaying the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen arising from the aorta (AO) and passing anteriorly traversing the lesion. It also shows that the lesion is deep within the pericardium (P) with pericardial effusion
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F1
The acquired volumetric data were used to reconstruct multiplanar reformatted (MPR) images, maximal intensity projections (MIP), and volume rendering (VR) images [Figure 1a]. The right coronary artery (RCA) was seen splayed at its origin at the upper border of the lesion with some of its branches seen passing through the lesion [Figure 1b].
(a) TFE-DW 3T MR image in the axial plane showing the lesion (L) as a hypointense structure splaying the hyperintense right atrium (RA) and right ventricle (RV). (b) T1-weighted FSE of the heart in the axial plane showing the heterogenously hyperintense lesion (L) with internal septae within involving the anterior mediastinal region, centered on the atrioventricular groove between the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen passing inside the lesion appearing as a signal void vessel. (c) T2-weighted TSE-BB 3T MR image of the heart showing the hyperintense lesion (L) abutting the right atrium (RA) and right ventricle (RV) which display a hypointense signal. The heterogenous intermediate-to-bright signal of the pericardial effusion (P) is seen at the right lateral aspect of the lesion
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F2
T1, T2 turbo spin echo (TSE), balanced turbo field echo (BTFE), and turbo field echo - diffusion weighted (TFE-DW) sequences. This confirmed the CT findings and the soft tissue mass elicited a heterogeneous hyperintense signal in T1 WI with an intense bright pattern on T2WI, showing internal intermediate heterogenous septae [Figure 2a]. The right coronary artery and its branches were seen traversing the lesion likely encased by this soft tissue, predominantly cystic, lesion [Figure 2b] and encysted pericardial effusion was seen [Figure 2c].
Photomicrograph of the lesion after surgical removal using the H and E stain with a x100 magnification showing spaces lined by flat endothelial cells with a homogenous pink material, hence diagnosing cavernous lymphangioma
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F3
The tumor was then sent for histopathological evaluation revealing a cystic cardiac lymphangioma [Figure 3].