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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The article by Toscano et al&#46; published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> is an interesting case report that combines a febrile picture with positive blood cultures suggesting endocarditis&#44; with a mass on the mitral valve that&#44; unexpectedly&#44; turned out to be a rare tumor&#44; a cardiac hemangioma&#46; In the report&#44; the authors considered two hypotheses&#44; one of which was that of endocarditis in an abnormal and distorted valve due to the growth of a benign tumor&#46; Although very rare&#44; this was supported by a further episode of endocarditis eight months later&#46; Against this is the fact that cultures of the valve were sterile&#46; The second hypothesis is that the tumor itself caused the fever&#46; Although this is also rare&#44; there is a previously published case of a cardiac hemangioma with systemic symptoms of pyrexia of unknown origin and disseminated intravascular coagulation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Primary cardiac tumors are rare&#46; The reported prevalence is between 0&#46;0017&#37; and 0&#46;028&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> and they account for 1 in every 500 cardiac surgical cases in large centers&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> About 90&#37; of primary cardiac tumors are benign&#46; The most frequent are myxomas<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and the second most common are fibroelastomas&#46; All other tumors are extremely rare&#46; The great majority are asymptomatic and are often an incidental finding on echocardiography or other chest imaging&#46; Although cardiac hemangiomas are benign&#44; they potentially present high clinical risk secondary to inflow&#47;outflow tract obstruction&#44; conduction system involvement and cerebral or peripheral embolism&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Because of this&#44; prompt assessment and definitive treatment are mandatory&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cardiac hemangiomas are very rare vascular tumors&#59; only about 200 cases have been described in the literature&#46; They are due to a benign proliferation of endothelial cells and are of three types &#8211; capillary &#40;smaller capillary-like vessels&#41;&#44; cavernous &#40;multiple&#44; dilated&#44; thin-walled vessels&#41; and arteriovenous &#40;dysplastic malformed arteries and veins&#41;&#46; Cavernous hemangioma is the predominant subtype&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It can occur in any heart chamber&#44; and in all cardiac layers&#58; pericardium&#44; endocardium&#44; or myocardium&#46; Valvular involvement is rare and&#44; due to the avascular anatomy of the heart valves&#44; such tumors are located on the peripheral tissue near the valve ring&#44; which is more vascularized&#46; Their natural history is unpredictable and spontaneous shrinkage can take place&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Echocardiography is the main tool for screening and diagnosis of most cardiac masses&#46; Hemangiomas appear as a homogeneous solid mass&#44; without the usual location and mobility of myxomas and fibroelastomas&#46; Cardiac computed tomography and magnetic resonance imaging &#40;MRI&#41; have recently been used in the assessment of intra- and extra-cardiac masses and further depict their relationship to other cardiac structures&#46; MRI can improve the diagnosis of tumor type through its signal intensity characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This is a very rare and interesting clinical case&#44; which started as endocarditis with significant mitral valve destruction and ended as a benign mitral valve tumor with possible endocarditis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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