A large angiosarcoma of the right atrium: anaesthetic management

We present the case of a young man diagnosed with a right atrial mass and a large pericardial effusion. The patient had presented in the emergency department with chest pain, shortness of breath, pedal oedema and loss of appetite. A transthoracic echocardiogram showed a bright echodensity in the right atrium with a large pericardial effusion. He was treated for presumed tubercular pericardial effusion. Pericardiocentesis showed a straw-coloured non-tubercular pericardial effusion. Surgical removal of the right atrial tumour was planned with cardiopulmonary bypass support. The tumour could only be partially resected due to large adhesions with the myocardium. The patient suffered a cardiorespiratory arrest in the intensive care unit 3 hours after surgery due to persistent bleeding in the pericardial cavity with refractory hypovolemic shock and could not be revived. The pathological examination performed later revealed a primary cardiac angiosarcoma. The case highlights the initial clinical presentation, current diagnostic modalities, and anaesthetic management options for cardiac angiosarcoma.