Cardiac Capillary Hemangioma in a Patient Presenting with Syncope: Report of a Case and Systematic Review of the Literature

Background: Primary cardiac tumors (PCTs) are exceptionally rare, accounting for less than 0.7% of all cardiac masses. Among these, cardiac hemangiomas are uncommon benign neoplasms, accounting for less than 2% of all PCTs, with the capillary subtype representing only a small fraction. Clinical presentation is often nonspecific and depends on the size, location, and mobility of the tumor. Syncope as the initial manifestation is exceedingly rare. Case Summary: We report the case of a 53-year-old woman who presented with recurrent episodes of syncope and no preceding cardiac symptoms. Initial neurological investigations were unremarkable. Transthoracic echocardiography revealed a mobile, pedunculated intraventricular mass attached to the mid-ventricular septum near the posteromedial papillary muscle. Cardiac MRI confirmed a well-defined, hypervascular lesion consistent with a benign cardiac tumor, initially suspected to be cardiac myxoma. The patient underwent successful surgical excision via superior partial sternotomy. Histopathological and immunohistochemical analyses confirmed the diagnosis of a capillary hemangioma. The postoperative course was uneventful, and postoperative imaging showed no recurrence. In addition, we provide a systematic review of the literature, identifying 46 studies comprising 49 patients with histopathologically confirmed cardiac capillary hemangiomas or mixed hemangiomas containing a capillary component. The review demonstrated considerable heterogeneity in patient age, clinical presentation, and tumor localization, with the right atrium and left ventricle being the most frequently affected sites. Surgical resection was the predominant treatment approach, while long-term follow-up data remained limited. Discussion: This case highlights the diagnostic challenge of distinguishing cardiac hemangiomas from other benign cardiac masses based solely on imaging. It underscores the importance of considering cardiac causes in patients presenting with unexplained syncope and the role of early echocardiographic evaluation. Definitive diagnosis requires histopathological confirmation, and surgical resection may be beneficial to prevent hemodynamic or embolic complications and to establish tissue diagnosis. Our systematic review also shows that diagnosing these rare tumors remains challenging, as their clinical presentations vary widely and their imaging features often resemble those of other cardiac masses.