[A case of angiosarcoma presenting as ill-defined opacities on chest roentgenogram and hemothorax]

A 74-year old male was referred to the Tokai University Hospital for evaluation of abnormal opacities on a chest roentgenogram. Laboratory tests demonstrated leukocytosis, elevated ESR and CRP, elevated LDH, and hypoxemia. The chest roentgenogram demonstrated several ill-defined nodular infiltrates on the bilateral upper lung fields. In addition, a CT scan revealed bilateral pleural effusion which was found bloody on diagnostic thoracocentesis. Administration of antibiotics failed to improve lung infiltration or laboratory data. The patient died of respiratory failure on the 23rd hospital day. At autopsy, multiple ill-defined nodules, which were associated with alveolar hemorrhage, were scattered in the lungs bilaterally. Both hematoxylin-eosin and silver staining showed atypical cells of a vasoformative nature. Factor VIII related-antigen in the tumor cells was confirmed by the peroxidase-antiperoxidase method. These findings were consistent with angiosarcoma. The tumor foci were demonstrated in the lungs, pleura, kidneys, bone marrow, adrenal glands, and the gastrointestinal tract. The primary site of angiosarcoma, however, was not identified. Angiosarcoma, either primary or metastatic to the lungs, should be included in the differential diagnosis of multiple ill-defined nodular opacities associated with hemothorax.