Angiosarcoma in a pregnant woman presenting with pericardial tamponade--a case report and review of the literature

Cardiac tamponade during pregnancy due to primary lung cancer: A case report

We report a rare case of cardiac tamponade caused by lung cancer in a pregnant woman. A 32-year-old multiparous pregnant woman was admitted to the hospital at 15 weeks of gestation with a persistent cough and dyspnea. Transthoracic echocardiography revealed a pericardial effusion with evidence of tamponade physiology. Computed tomography (CT) revealed a massive pericardial effusion and a left lung tumor. Pericardial tamponade was successfully treated using pericardiocentesis. She was diagnosed with lung adenocarcinoma stage IVB based on bronchoscopic lung biopsy, which showed adenocarcinoma and CT, which showed brain metastasis. Pregnancy was terminated at 18 weeks of gestation, followed by molecular-targeted therapy with alectinib hydrochloride and whole-brain irradiation. 24 months after treatment initiation the patient is alive without disease progression. Although pericardial tamponade caused by a malignant tumor during pregnancy is a rare and serious life-threatening condition, appropriate diagnosis and prompt treatment can improve maternal prognosis.

Perigraft hygroma mimicking recurrent angiosarcoma of the right atrium

Primary cardiac angiosarcoma is extremely rare, has a poor prognosis and has no specific clinical manifestation. A 31-year-old pregnant woman presented to the emergency department with signs of pericardial tamponade. Transesophageal echocardiography (TEE) showed a mass within her right atrium. Extensive surgical resection was performed with subsequent pericardial patch reconstruction of the right atrium. Histological examination showed the presence of an angiosarcoma. A reoperation was performed 18 months after the initial operation, because of concerns of radicality. Three years later she was re-admitted with a superior caval vein syndrome. A stent was placed to relieve symptoms. Because of the suspicion of a recurrent tumor, a second reoperation followed. During this operation, a perigraft hygroma was found pressing against the previously reconstructed superior caval vein. Histological examination after both reoperations showed no signs of a recurrent angiosarcoma. Until today, 8 years after her first surgery, the patient is still alive without any signs of recurrent tumor.

Evaluation and Treatment of Cardiac Tamponade in a Pregnant Patient

Cardiac tamponade is an uncommon but life-threatening emergency that may occur in pregnant women. There is a plethora of causes, but prompt diagnosis and intervention is imperative to optimize both maternal and fetal outcomes. We report on a case of a large pericardial effusion leading to cardiac tamponade occurring in the 32^nd week of gestation in a previously healthy woman. Rapid recognition and a multidisciplinary team meeting resulted in a therapeutic pericardial window and drainage and relief of symptoms. The woman underwent an uncomplicated repeat cesarean delivery at term with a positive neonatal outcome. This case highlights the importance of a rapid diagnosis and a team-based approach to managing a complex medical condition like cardiac tamponade in pregnancy.

Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a Pregnant Woman

Pericardial effusions are common in pregnancy and often remain asymptomatic. We present a case of cardiac tamponade in a young pregnant female unmasking a diagnosis of primary metastatic lung adenocarcinoma. (Level of Difficulty: Intermediate.)

Primary cardiac angiosarcoma diagnosed in the first trimester of pregnancy

Primary cardiac angiosarcoma (PCAS) is a malignancy seldom seen in pregnancy. A 23-year-old G1P0 Chinese female was found to have PCAS during her first trimester when she presented with tamponade physiology. The transthoracic echocardiography (TTE) results did not indicate the presence of an intracardiac lesion, and pericardial fluid cytology analysis showed no evidence of malignancy. Cardiac magnetic resonance imaging (CMRI) exhibited a right atrial mass, and tissue biopsy indicated a high-grade angiosarcoma. MRI of the abdomen was suggestive of liver metastasis. She underwent an abortion and was started on combination chemotherapy, with a reduction in both the cardiac and liver masses. In cardiac angiosarcomas, advanced imaging modalities such as MRI should be utilised when there is high clinical suspicion or in the case of pregnancy when trying to minimise foetal harm. Prognosis is poor, and a standardised treatment protocol regardless of pregnancy continues to elude the medical community.

Elusive Cardiac Angiosarcoma in a Young Pregnant Female: Rare Presentation With Fatal Outcome

Heart tumors are rare occurrences. They can present diagnostic challenges and severe complications especially in pregnant women. We report a rare case of angiosarcoma (AS) cordis of the right atrium in a young healthy pregnant female. Her diagnosis remained elusive for some time until development of advanced disease symptomatology. The diagnosis was unfortunately clinched when her tumor grew to be detected by imaging modalities. An emergency cesarean section was performed delivering a healthy baby. The patient was aggressively treated with chemotherapy to no avail. She passed away 2 months after her diagnosis was established. Only few cases of the occurrence of aggressive cardiac AS and human pregnancy are documented. The course of this disastrous combination is usually marked by severe complications, difficult therapeutic options and ultimately fast demise. Physicians need to be more aware of such diagnosis and diligently try to diagnose it as early as possible.

Angiosarcomas of the bilateral breast and heart: which one is the primary site?

A 29-year-old pregnant woman with recurrent pericardial effusion and a cardiac tumor, diagnosed as an angiosarcoma, was treated with surgical resection of the tumor followed by radiotherapy. Immediately after completion of radiotherapy, she developed bilateral breast masses, which were also confirmed as angiosarcomas. We thought this might be the first case of bilateral angiosarcoma of the breast metastasizing to heart mimicking a primary cardiac angiosarcoma, although we could not conclude with certainty that angiosarcoma of the heart was not the primary site.

Gross pericardial effusion with tamponade in 2nd trimester of pregnancy

Hypothyroidism in pregnancy is associated with serious maternal and fetal risk. Rarely, it is manifested by life-threatening cardiac complications, such as gross pericardial effusion and tamponade. We present a case of successfully treated gross pericardial effusion and tamponade in a 22-week pregnant woman with hypothyroidism. The patient was treated by pericardial drainage with further treatment of hypothyroidism with levothyroxine. During the follow-up pregnancy was uncomplicated without recurrence of pericardial effusion and successful delivery of full-term baby. We conclude that careful monitoring of thyroid functional tests and proper management should be performed in pregnant women with hypothyroidism to prevent cardiac complications of the disease, like pericardial effusion and tamponade.