Localization of angiosarcoma by peri-operative transesophageal echocardiography

Transthoracic echocardiography (TTE), computed tomography (CT) and magnetic resonance (MR) cannot always clearly identify angiosarcoma. A 22 year old woman presented with dyspnea. Preoperative TTE showed no tumor, and CT and MR both gave the impression that an extra-cardiac, mediastinal tumor was present. Transesophageal echocardiography (TEE), performed during surgery showed an intra-cardiac tumor, which was a well-delineated mass at the intra-ventricular groove of the right heart and surrounding the superior vena cava. The tumor was excised and found to be a malignant angiosarcoma. TEE provides diagnostic advantages over other cardiac imaging techniques and can serve as a useful adjunct during and before intrathoracic surgery.