Chest Pain and ST-Segment Elevation: Angiosarcoma Discovered With Coronary Angiography
Paul J Pecorin1, Joshua Dein1, Daneyal Syed1
1Rush University Medical Center, Chicago, Illinois, USA.
Insights
Rare primary cardiac angiosarcomas can cause chest pain. This case highlights coronary angiography as a unique diagnostic tool for identifying these heart tumors, even in emergencies.
Area of Science:
- Cardiology
- Oncology
- Diagnostic Imaging
Background:
- Primary cardiac angiosarcomas are rare, aggressive heart tumors.
- Symptoms include chest pain and heart failure, often mimicking other cardiac conditions.
- Diagnosis typically involves echocardiography and biopsy.
Observation:
- A 56-year-old male presented with acute chest pain and shortness of breath.
- Electrocardiogram showed ST-segment elevations, prompting urgent coronary angiography.
- Angiography revealed no coronary disease but identified a mass near the right atrium.
Findings:
- The mass was diagnosed as primary cardiac angiosarcoma.
- This represents a unique case of angiosarcoma discovered via coronary angiography.
- The tumor presented as a cardiac structure with delayed contrast filling.
Implications:
- Coronary angiography can reveal non-coronary cardiac pathologies like angiosarcoma.
- Clinicians should consider angiography for unexplained chest pain, even during emergency evaluations.
- Early screening for metastatic disease is crucial for treatment planning and biopsy guidance.
Abstract:
Primary cardiac angiosarcomas are rare malignant tumors that can cause chest pain and heart failure symptoms. They can be diagnosed using multimodality imaging, primarily echocardiogram, with formal diagnosis requiring biopsy. A 56-year-old man with history of hypertension and dyslipidemia presented with acute crushing chest pain and shortness of breath. Electrocardiogram showed diffuse ST-segment elevations. Urgent coronary angiography revealed no significant coronary disease but found delayed contrast filling from the left coronary artery to a structure overlying the right atrium with further work-up revealing primary cardiac angiosarcoma. This case represents a unique scenario in which primary cardiac angiosarcoma was discovered from coronary angiography. Clinicians should prioritize and rule out life-threatening emergencies but should recognize the utility of angiography in elucidating other etiologies of chest pain (eg, angiosarcoma). Finally, early screening for metastatic disease should be completed to identify alternative potential biopsy targets.
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