Primary cardiac angiosarcoma - a diagnostic roller-coaster till fatality

Area of Science:

• Cardiovascular Pathology
• Medical Imaging
• Oncology

Background:

• Pericardial effusion can present diagnostic challenges, especially in tuberculosis-endemic regions.
• Intracardiac masses require accurate and timely diagnosis for appropriate management.

Observation:

• A 28-year-old male presented with dyspnea and cardiac tamponade due to a large pericardial effusion.
• Echocardiography identified an intracardiac mass in the right atrium with pericardial and superior vena cava infiltration.
• Positron emission tomography (PET) scan revealed a metabolically active lesion with regional lymph node involvement.

Findings:

• Histologic examination of an open surgical biopsy confirmed cardiac angiosarcoma.
• Percutaneous endomyocardial biopsy was unrewarding.
• The patient developed refractory shock and recurrent hemorrhagic pericardial effusion post-biopsy.

Implications:

• This case underscores the importance of multimodality imaging in diagnosing cardiac malignancy.
• It highlights the diagnostic dilemma of pericardial effusion in endemic areas.
• Cardiac angiosarcoma carries a poor prognosis, necessitating aggressive diagnostic and therapeutic strategies.