Abstract Body (Do not enter title and authors here):
Background:
Primary cardiac tumors are rare, occurring in 0.001% - 0.03% of the general population, most discovered at autopsy. Approximately 75% of these tumors are benign, of which 2% represent cardiac hemangiomas. While most cardiac tumors are silent, devastating clinical symptoms have been documented including cardiac tamponade, arrhythmia, stroke and death. Such presentations may manifest at any age and are related to the tumor’s size and location.

Case Description:
A 68-year-old male with a history of OSA was referred to cardiology by his primary care provider after an incidental finding of left ventricular hypertrophy on EKG. Examination was significant for a grade III late systolic murmur. Echocardiography revealed severe mitral regurgitation, mitral valve (MV) prolapse and an epicardial mass suggestive of a tumor. Cardiac CT demonstrated an epicardial tumor of the left atrial appendage, uplifting the left main coronary artery, displacing the proximal LAD and first diagonal branch (Diag)_{(figure 1).} Cardiac catheterization ruled out significant CAD, but identified tumor blush from the Diag_{(Figure 2a).}
Surgical intervention, including MV repair, was successful. Resection of the mass required extrication from the Diag, the proximal LAD and 1st septal branches, which was performed without compromise of coronary vessels. Pathology confirmed a diagnosis of epicardial cavernous hemangioma_{(Figure 2b).} Patient is doing well 1 year post intervention.

Discussion:
This case illustrates the diagnostic and therapeutic challenges of primary cardiac tumors. As with our patient, cardiac tumors are often found incidentally. However, surgical resection is recommended as the consequences of tumor growth and/or invasion into surrounding structures is unpredictable and poses a significant morbidity and mortality risk. Comprehensive imaging and an interdisciplinary collaboration between medical and surgical personnel is essential for timely diagnosis and appropriate treatment planning.