Primary Cardiac Angiosarcoma with Right Atrial Rupture

TL;DR

A rare case of primary cardiac angiosarcoma was misdiagnosed preoperatively, leading to a fatal outcome, highlighting the difficulty in early detection of this aggressive cancer.

Contribution

This report presents a unique clinical case of undetected primary cardiac angiosarcoma with right atrial rupture, emphasizing diagnostic challenges and the need for early intervention.

Findings

Primary cardiac angiosarcoma was confirmed postoperatively despite preoperative imaging and cytology suggesting a coronary fistula.

The case highlights the nonspecific clinical features of PCA, leading to delayed or missed diagnosis.

Early therapeutic intervention is critical for PCA due to its aggressive nature and frequent metastases at diagnosis.

Abstract

A 47-year-old man presented with a recurrent refractory bloody pericardial effusion. Based on the preoperative imaging and pericardiocentesis results with negative cytology, we concluded that blood from a coronary fistula caused the repeated cardiac tamponade. However, pathological findings of the right atrial tissue confirmed primary cardiac angiosarcoma. In this report, we present a unique case as it involves a preoperatively or intraoperatively undetected tumour and a primary cardiac angiosarcoma that induced a fatal outcome, emphasizing the importance of early therapeutic intervention.

Primary cardiac angiosarcoma (PCA) is a rare malignancy with nonspecific features mimicking other cardiac tumours, making early diagnosis challenging, and distant metastases are frequently present at diagnosis.

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