Pleural angiosarcoma mimicking pleural haematoma

Pleural angiosarcoma is an extremely rare disease. Although the clinical course could be indolent, the prognosis is very poor once the tumour spreads. Herein, a 69-year old male with a history of thyroid goitre was noted for 5 years before the symptoms of right chest pain and body weight loss developed. His serial chest roenterogram revealed loculated pleural effusion which rapidly progressed to be multiple pleural haematomas. After several sono-guided aspiration/biopsies with undiagnosed pleural haematomas, an exploratory thoracotomy confirmed the diagnosis of pleural angiosarcoma. Whole body image studies did not find other suspicious primary sites except for a thyroid tumour with eccentric calcification extending into the thoracic cage. Aspiration cytology of the thyroid tumour was shown to be morphologically consistent with angiosarcoma. This case reminds clinicians that pleural metastatic angiosarcomas presenting as haematomas have a high risk of massive and refractory haemothorax.