Background: Primary cardiac angiosarcoma is rare. It is typically located in the right atrium and manifests as right-sided heart failure or cardiac tamponade. Most patients are symptomatic at presentation and when disease is discovered, it is often late in its course, resulting in a poor prognosis. We describe a case of hemorrhagic tamponade due to right atrium angiosarcoma.
Case presentation: A healthy 53-year-old man presented to lung diseases hosptital after one month of hemoptysis. He was started on antibiotics for suspected pneumonia. Over the next few weeks, the hemoptysis worsened and a chest computer tomography was performed.The result was a tumor in right atrium, then he was referred to our institution for further evaluation. Cardiac MS-CT showed a heterogeneous tumor in right atrium 6.5 x 8.0 x 8.0 cm in size suspected angiosarcoma, moderated pericardial effusion (Fig.) PET-CT showed hypermetabolic tumor in right atrium, paratracheal lymph nodes and intrapulmonary nodes. Over one week he suddenly developed dyspneic, hypotensive, and tachycardia. Examination revealed distended jugular veins, distant heart sounds, and diminished lung sounds at the bases. A transthoracic echocardiogram demonstrated a large circumferential pericardial effusion with evidence of cardiac tamponade. He was transfered to emergency surgery. A large amount of blood was found in the pericardial space. Direct invasion of the tumor to the pericardium detected. The tumor was located on the wall of the right atrium and extended over the epicardium. Bleeding from the tumor had ceased after sewing and blood drainage. A piece of tumor was resected and the pathological examination revealed primary cardiac angiosarcoma.
Discussion: Primary cardiac angiosarcomas are rare. Most patients present with symptoms related to heart failure and tamponade.The patient described here had numerous extensive pulmonary metastases, hemoptysis and tamponade. The majority of the primary tumor site is located in the right atrium, and the most common site for metastasis is the lung or the pericardium. Computed tomography scanning confirms the diagnosis of a cardiac mass.
Conclusion: Primary cardiac angiosarcomas-such as our patient's tumor-are highly aggressive and locally invasive. The tumor usually arises from the right atrium, with nonspecific symptoms and signs. Very rarely, the tumor presents with rupture, which leads to hemopericardium, cardiac tamponade, and a poor prognosis. In our patient, the surgery also controlled the bleeding and prevented death from cardiac tamponade; further, it provided a tissue specimen for diagnosis.