Clinical and imaging manifestations of primary cardiac angiosarcoma

BACKGROUND: To investigate the CT manifestations of primary cardiac angiosarcoma. METHODS: The clinical and CT data for 9 patients with cardiac angiosarcoma were retrospectively analyzed. RESULTS: The lesions in all nine cases were located in the right atrium. In two cases, the involved lesion led downward to the tricuspid valve and right ventricle, and the dynamic cine showed that the lesion affected the opening and closing of the tricuspid valve. In three cases, the lesion involvement led to a thickened pericardium, accompanied by pericardial effusions. On CT plain scans, six patients showed homogeneous density, while three showed inhomogeneous density, two of which were associated with bleeding. On enhanced CT scans, seven patients showed heterogeneous centripetal enhancement, and some angiograms showed lesions with tortuous small blood vessels. The remaining two cases showed early stage rapid inhomogeneous enhancement. Five cases showed multiple metastatic nodules in the lungs at the time of initial diagnosis; four of these showed distinct sharp edges in multiple pulmonary nodules. CONCLUSIONS: Cardiac angiosarcoma has a predilection site and is prone to invading adjacent structures, manifesting as malignant pericardial and pleural effusions. The CT enhancement manifestations are mostly inhomogeneous and centripetal with ground-glass opacity peripheral to the intrapulmonary metastases.