Primary Cardiac Angiosarcoma Accompanying Cardiac Tamponade

Abstract

A de novo cardiac malignant tumor is rare and sometimes challenging to diagnose. We encountered a 67-year-old man without any medical history complaining of dyspnea on effort. On admission, his hemodynamics were deteriorated due to cardiac tamponade, which was improved by percutaneous drainage of 1,200 mL pericardial effusion, showing 11.0 g/dL of hemoglobin. We suspected primary cardiac malignancy following multidisciplinary tests, and a cardiac biopsy via sternotomy demonstrated the definitive diagnosis of primary malignant tumor (angiosarcoma) infiltrating the right atrial myocardium. We initiated weekly paclitaxel therapy. Further studies are warranted to establish the optimal diagnostic and therapeutic strategy for de novo cardiac malignancy.

Keywords: cardiogenic shock; heart failure; hemodynamics; pericardial effusion.

Figure 1.

Chest X-ray (A), electrocardiogram (B), transthoracic echocardiography showing circumference pericardial effusion, obtained in the long-axis view (C) and four-chamber view (D), and chest computed tomography showing circumference pericardial effusion without perforation of myocardium, obtained as a plane procedure (E) and as an enhanced procedure (F). PE: pericardial effusion, LV: left ventricle, LA: left atrium, RV: right ventricle, RA: right atrium

Figure 2.

Detailed assessments of the cardiac tumor using cardiac computed tomography (A), trans-esophageal echocardiography (B), coronary angiography (C), positron emission tomography (D), and multi-slice chest computed tomography. Heterogeneous deficiency (red arrow) in the right atrium (A); a heterogeneous mass (yellow arrow) with an irregular border in the right atrium (B); collateral arteries from right coronary artery (yellow circle; C); strong staining at the free wall of the right atrium (red arrow; D); multiple ground-glass appearances in the bilateral lungs (green circles; E).

Figure 3.

Histopathological image of the cardiac tumor obtained by a surgical biopsy that was diagnosed as cardiac angiosarcoma [×4 with Hematoxylin and Eosin (H&E) staining (A) and ×10 with H&E staining (B)].