Mediastinal angiosarcoma mimicking constrictive pericarditis and aortic dissection: a case report.

Area of Science:

• Oncology
• Pathology
• Cardiovascular Surgery

Background:

• Angiosarcomas are rare endothelial cell soft-tissue sarcomas with poor prognosis and no established treatments.
• Primary mediastinal angiosarcoma presents diagnostic challenges due to non-specific clinical findings and potential absence of a detectable tumor mass.
• This condition can manifest in the heart, lung, aorta, or pulmonary artery.

Purpose of the Study:

• To highlight the diagnostic complexities of primary mediastinal angiosarcoma.
• To present a case where mediastinal angiosarcoma mimicked multiple cardiovascular conditions.
• To investigate potential biomarkers for diagnosing mediastinal angiosarcoma.

Main Methods:

• A case report of a 49-year-old male patient presenting with syncope.
• Diagnostic workup included cardiac catheterization and computed tomography, initially suggesting constrictive pericarditis, aortic dissection, and coronary artery disease.
• Intraoperative findings revealed a malignant tumor, leading to pericardiectomy and subsequent diagnosis of mediastinal angiosarcoma confirmed by postoperative analysis, including pleural fluid hyaluronic acid concentration.

Main Results:

• Initial investigations suggested multiple cardiovascular pathologies, delaying the diagnosis of mediastinal angiosarcoma.
• Intraoperative findings were critical in identifying the underlying malignancy.
• Elevated hyaluronic acid concentration in pleural fluid was observed in the patient.

Conclusions:

• Mediastinal angiosarcoma can present with diverse clinical and imaging findings, mimicking various other diseases.
• Elevated hyaluronic acid concentration in pleural fluid may serve as a valuable diagnostic indicator for mediastinal angiosarcoma.
• Early and accurate diagnosis is crucial for managing this rare and aggressive malignancy.