Primary Cardiac Angiosarcoma Leading to Tamponade and Fatal Right Atrial Rupture

While rare, primary cardiac tumors, especially angiosarcomas, have a high mortality rate and are difficult to diagnose due to vague symptoms and limited visibility on transthoracic echocardiogram.

A 47-year-old patient was treated for acute pericarditis with transient resolution of a pericardial effusion but persistent dyspnea, chest pain, fatigue, and elevated inflammatory markers. Six months after the initial presentation, they developed tamponade, had hemorrhagic shock, and passed away due to right atrial rupture from an infiltrative tumor. Pathology demonstrated primary cardiac angiosarcoma.

This case illustrates the diagnostic challenges and consequences of a cardiac tumor which was not apparent on serial echocardiograms.

Primary cardiac malignancy should be considered in the setting of recurrent pericardial effusion with systemic symptoms and persistently elevated inflammatory markers. Echocardiogram has shown low sensitivity for cardiac tumors in the setting of effusion; advanced imaging modalities can facilitate early detection and intervention.