Ruptured cardiac angiosarcoma with pulmonary metastases: a rare disease with a common (mis)diagnosis!

Abstract

In Indian settings pulmonary tuberculosis remains the most common diagnosis in a patient presenting with constitutional symptoms, hemoptysis and lung opacities. We describe a case report of a fifty-year-old woman who was receiving empirical anti-tubercular drugs for a metastatic illness to lungs arising from a primary angiosarcoma in the right atrium. This rare entity was misdiagnosed and typical echocardiographic findings suggested this diagnosis.

Fig. 1

Chest X-ray reveals right-sided pleural effusion with multiple nodular opacities in both lung fields. Consolidation of right middle lobe also noted silhouetting right heart border.

Fig. 2

(A) Apical 4c view showing friable looking sessile, mobile mass (✰) arising from right atrial wall and a large loculated effusion around right atria and ventricle. (B) Apical 4c view showing leakage of saline bubble contrast (white arrow) from right atrial free wall to surrounding pericardial effusion thus confirming atrio-pericardial fistula.

Fig. 3

(A) Axial CT reveals multiple non cavitating nodular lesions of varying sizes scattered in bilateral lung parenchyma in angiocentric distribution suggesting metastatic deposits. Bilateral pleural effusion (R > L) is also seen. (B) Contrast enhanced axial CT reveals pericardial collection communicating with right atria and causing attenuation of the right ventricle. Associated papillary like projection (*) noted in the free wall of the right atria.