Right Atrial Epithelioid Angiosarcoma in a 44-Year-Old Woman: A Case Report

Primary cardiac angiosarcoma is a rare and aggressive malignancy that often presents with nonspecific symptoms, leading to delayed diagnosis. Early detection through multimodality imaging is essential for management. A 44‑year‑old woman with no significant medical history presented with six weeks of vague symptoms that included intermittent retrosternal burning chest pain, palpitations, dyspnea, lightheadedness, and bilateral arm paresthesias. Outpatient evaluation revealed a suspicion for a right atrial mass on transthoracic echocardiogram. Her symptoms progressed, accompanied by episodes of bradycardia into the 40s, prompting emergency evaluation. Laboratory studies were largely unremarkable. CT angiography showed no pulmonary embolism, and staging CT scans revealed no metastases. Cardiac MRI demonstrated a 3.0 × 1.5 cm sessile right atrial mass with homogeneous enhancement. She underwent open-heart surgery with complete en bloc resection of the right atrial wall and reconstruction using bovine pericardium. Pathology confirmed epithelioid angiosarcoma. She had an uneventful postoperative recovery from her open-heart surgery. MRI brain and postoperative PET scan showed no evidence of residual disease or metastasis. She was offered adjuvant chemotherapy but chose close oncologic surveillance. This case highlights the importance of multimodality imaging in diagnosing cardiac tumors, the feasibility of extensive right atrial resection with reconstruction, and the complexity of postoperative management in cardiac angiosarcoma.