Case Report: Cardiac angioma with multiple pulmonary angiomatous nodules: a rare presentation of systemic angiomatosis

Background: Primary cardiac tumors are clinically rare. When these tumors coexist with multiple bilateral pulmonary nodules, diagnosis becomes more complex and requires consideration of rare diseases, such as lymphangioleiomyomatosis and pulmonary epithelioid hemangioendothelioma. Case presentation: This report describes a 40-year-old female patient incidentally found to have a paraventricular cardiac mass and multiple solid lung nodules. A multidisciplinary team assessed her case. Because of the high risk of cardiac biopsy due to the mass's proximity to the coronary artery, a thoracoscopic wedge resection of a pulmonary nodule was performed instead. Immunohistochemical results-SMA(+), D2-40(focal +), CD31(+), CD34(+), Desmin(+), and HMB45(-)-confirmed angioma. Based on intraoperative findings and pulmonary pathology, the cardiac lesion was strongly suspected to be a homologous angioma. Thus, high-risk cardiac biopsy was avoided. The patient recovered well and remained stable, with no new lesions, over one year of follow-up. Conclusion: This case illustrates a rare co-occurrence of cardiac angioma and multiple pulmonary angiomas, expanding angioma's known systemic spectrum. It emphasizes the critical role of multidisciplinary collaboration in managing complex cardiopulmonary masses and the need for individualized, risk-averse surgical strategies. For patients with multiple pulmonary nodules and mediastinal or cardiac masses, angioma should be in the differential diagnosis. Detailed immunohistochemical analysis is crucial to accurately distinguish this tumor from other vascular and mesenchymal tumors.