A rare cause of pericardial constriction in a young man

Primary cardiac angiosarcoma evaluated with contrast two-dimensional and real-time three-dimensional echocardiography

A 63-year-old lady presented with syncope and atypical chest pain. Conventional two-dimensional (2D) contrast echocardiogram showed a highly vascular mass compressing the right atrium without direct communication. A real-time three-dimensional echocardiogram (RT3DE) revealed its outer spatial relationship with the surrounding structures and its inner heterogeneity as well. A chest computed tomography revealed a solid cardiac mass (6 x 7 cm(2)) arising from the right atrium and multiple pulmonary nodules. Histopathology of the pericardial fluid confirmed angiosarcoma. To our knowledge, this is the first report of histology-confirmed primary cardiac angiosarcoma, which was completely evaluated by conventional 2D, contrast, and RT3DE.

Primary right atrium angiosarcoma mimicking pericarditis

BACKGROUND

Primary cardiac neoplasms occur rarely and most of them are benign. Malignant tumors including angiosarcoma are extremely rare and have a non specific clinical presentation and a poor prognosis.

CASE PRESENTATION

We present a case of a young male who was transferred to our hospital because of shock and multiple organ failure after a complicated pericardial biopsy. During the previous seven months he presented with recurrent episodes of pericardial effusions and tamponade. Chest computed tomography revealed a mass in the right atrium, infiltrating the myocardium and pericardium. During emergency surgery that followed, the patient died because of uncontrolled hemorrhage. Autopsy revealed the mass of the right atrium, which was identified on histological examination as primary cardiac angiosarcoma.

CONCLUSION

This case highlights the difficulties both in early diagnosis and in the management of patients with cardiac angiosarcoma.