# 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.

## Key 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.