C  2008, the Authors Journal compilation C  2008, Blackwell Publishing, Inc. DOI: 10.1111/j.1540-8175.2007.00610.x RESEARCH FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM Two- and Three-Dimensional Transthoracic and Transesophageal Echocardiographic Findings in Epithelioid Hemangioma Involving the Mitral Valve Harvinder S. Dod, M.D., ∗ Manjula V. Burri, M.D.,§ Deepak Hooda, M.D., ∗ Venu Sajja, M.D., ∗ Wasif Qureshi, M.D., ∗ David Massinople, M.D., ∗ Muhammad H. Nazim, M.D.,† Charles Murray, ∗ Ganga Prabhakar, M.D.,† H. James Williams, M.D.,‡ Bradford Warden, M.D., ∗ Robert Beto, M.D., ∗ Abnash C. Jain, M.D., ∗ and Navin C. Nanda, M.D.§ ∗ Department of Medicine, Section of Cardiology, †Department of Surgery, Section of Cardiothoracic Surgery, ‡Department of Pathology, West Virginia University, Morgantown, West Virginia, and §Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama We are describing two-dimensional and live/real time three-dimensional transthoracic as well as two-dimensional transesophageal echocardiographic findings in an elderly patient with epithelioid hemangioma involving the anterior leaflet of the mitral valve. (ECHOCARDIOGRAPHY, Volume 25, April 2008) hemangioma, mitral valve tumor, cardiac tumor, echocardiography, three-dimensional echocardio- graphy Hemangiomas account for 5–10% of all be- nign cardiac tumors. 1,2 Valvular involvement is extremely rare and to the best of our knowl- edge, so far 11 cases affecting the cardiac valves have been reported in the English literature and none of them was an epithelioid heman- gioma. 3 We describe an 86-year-old Caucasian female patient with incidental epithelioid he- mangioma of the mitral valve. She presented with chronic bilateral swelling of lower extrem- ities. Physical examination was unremarkable except for mild pitting edema of lower extrem- ities. Past medical history was significant for long-standing systemic hypertension, hypothy- roidism, and osteoporosis. A real time two-dimensional transthoracic echocardiogram (2DTTE) showed a large, mo- bile mass measuring 2.3 cm × 2.1 cm involv- Address for correspondence and reprint requests: Navin C. Nanda, M. D., University of Alabama at Birmingham, Heart Station SWB/S102, 619, 19th Street South, Birmingham, AL-35249. Fax: 205-934-6747; E-mail: nanda@uab.edu ing the anterior mitral leaflet. There were mul- tiple echolucencies within the mass consistent with a hemangioma, 4 but a myxoma could not be excluded (Fig. 1). In addition, there was a small pericardial effusion. Both left and right ventricular functions were normal. For further evaluation, a live/real time three-dimensional transthoracic echocardiogram (3DTTE) was performed in the standard manner 5 using an iE 33 ultrasound system and a phased ar- ray matrix 4 MHz transducer (Philips, Both- ell, WA, USA). This showed the mass (2.4 cm × 2.1 cm × 2 cm) to have a wide attachment to the base of the atrial aspect of the ante- rior mitral valve leaflet and prolapsing into the left ventricle in diastole. Cropping and section- ing of the full volume 3D data sets revealed multiple closely packed echolucencies involving the whole mass and extending all the way to the periphery consistent with a highly vascu- lar mass such as a hemangioma 4 (Fig. 2). A two-dimensional transesophageal echocardio- gram (2DTEE) performed to confirm the above Vol. 25, No. 4, 2008 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 443