Blunt Trauma-Induced Atrial Fibrillation as First Sign of an Unspecified Cardiac Hemangioendothelioma.

BACKGROUND

Hemangioendotheliomas are rare vascular tumors comprising different entities, and cardiac localization has been seldom reported.

CASE SUMMARY: A 40-year-old man presented with atrial fibrillation after blunt chest trauma. Subsequent transthoracic echocardiography revealed a large right atrial mass. Cardiac magnetic resonance imaging and positron emission tomography-computed tomography showed a nonmetastatic 76 × 76-mm tumor obstructing inflow and encasing the right coronary artery (RCA). Biopsy suggested a mesenchymal neoplasm. Radical resection of the right atrium and RCA was performed, with reconstruction using a bovine pericardial patch and a saphenous vein interposition graft. Histopathology confirmed a hemangioendothelioma without a definitive subtype. Recovery was uneventful, with restored cardiac function and no recurrence for 5 years.

DISCUSSION: Management according to sarcoma principles favors complete resection. Overall survival is poor, especially in patients with metastatic disease. This case is notable for trauma-associated atrial fibrillation, oncologic RCA resection, and venous graft reconstruction.

TAKE-HOME MESSAGES: Radical resection with coronary reconstruction is feasible. Unexplained, possibly smartwatch-detected arrhythmias after trauma warrant structural evaluation.