Cardiac Pseudomyogenic Hemangioendothelioma Presenting as Chest Pain in a Young Athlete.

backgroundPseudomyogenic hemangioendothelioma (PHE) is a rare tumor that can involve multiple tissues, including the heart. Its diagnosis is often elusive due to its rarity and atypical presentations, such as exertional chest pain in otherwise healthy individuals. CASE SUMMARY: A 40-year-old male athlete with no known comorbidities presented with chest pain during strenuous activities over 6 months. Exercise electrocardiogram demonstrated ischemic signs suggestive of left main coronary artery occlusion. Coronary computed tomography angiography revealed a heterogeneous mass partially occluding the circumflex artery and its branches. Additional radiological studies identified bilateral lung nodules, lytic bone lesions, and a muscle mass. A biopsy of the femur lesion confirmed the diagnosis of PHE. The patient experienced sudden death 3 months after diagnosis. DISCUSSION: This case highlights the diagnostic complexity of cardiac PHE, characterized by its rarity and atypical exertional chest pain, making it a notable contribution to the literature. TAKE-HOME MESSAGES: Consider rare cardiac masses like PHE in young patients with exertional chest pain mimicking coronary artery disease, as these can be aggressive and require timely detection. Utilize advanced imaging and immunohistochemistry for prompt diagnosis of infiltrative cardiac masses, enabling early intervention despite management challenges.