Multimodality Imaging of a Massive Intrapericardial Mediastinal Hemangioma: A Diagnostic Challenge.

CASE SUMMARY: A 68-year-old asymptomatic man with a massive intrapericardial mass had a severe iodinated contrast allergy. To break this diagnostic deadlock safely, an iodine-free multimodality approach combining 2'-deoxy-2'-[F-18] fluoro-D-glucose positron emission tomography/computed tomography, cardiac magnetic resonance, and contrast-enhanced ultrasound was deployed. Guided by 3-dimensional reconstruction, successful complete surgical resection of an adventitial mixed hemangioma was achieved. TAKE-HOME MESSAGE: When conventional iodinated contrast is strictly contraindicated, an iodine-free multimodality framework paired with 3-dimensional anatomical modeling offers a safe, guideline-compatible alternative for diagnosing and mapping complex cardiac tumors.