Primary Cardiac Angiosarcoma Diagnosed by Multimodality Imaging: A Case Report

Primary cardiac tumors are rare. Most primary cardiac tumors are benign, with approximately 10.83% being malignant. We present a rare case of Primary Cardiac Angiosarcoma (PCA) with multiple metastases diagnosed using multimodality imaging, to enhance the understanding of PCA among clinicians and radiologists.

A 29-year-old woman presented to our hospital with a 2-day history of chest tightness, chest pain, palpitations, and dyspnea after physical activity. Ultrasonography and Computed Tomography (CT) of the heart revealed a mass in the right atrium. Cardiac magnetic resonance imaging suggested either a large cardiac lymphoma or angiosarcoma. The histopathological diagnosis confirmed a cardiac angiosarcoma. Positron Emission Tomography-Computed Tomography (PET/CT) revealed intense 18F-fluorodeoxyglucose (18F-FDG) uptake in the right side of the heart, with a maximum standardized uptake value of 10.9. Three months later, the patient was re-examined using abdominal CT, echocardiography, and PET/CT. PET/CT revealed increased 18F-FDG uptake which had become more extensive, with multifocal metastatic nodules in both the lungs and mediastinum. The patient was lost to follow-up after being discharged on May 1, 2022.

The combined evaluation using multimodality imaging plays a vital role in determining the precise size and localization of the PCA, detecting distant metastases, and assessing patient prognosis.