Primary Cardiac Angiosarcoma Leading to Tamponade and Fatal Right Atrial Rupture

Figures

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  Figure 1. Initial Imaging at Presentation Showing Pericardial Effusion and Pulmonary Nodules (A) Transthoracic echocardiogram during the first admission in May 2024 demonstrating a moderate pericardial effusion measuring 1.25 cm in the parasternal long-axis view. (B) Computed tomography chest angiography obtained in May 2024 demonstrating diffuse scattered pulmonary nodules throughout both lungs.

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  Figure 2. Interval Imaging Demonstrating Resolution of Pericardial Effusion and Decrease in Pulmonary Nodules (A) Computed tomography chest obtained during outpatient care in July 2024 showing an interval decrease in the size of previously identified scattered bilateral pulmonary nodules. (B) Transthoracic echocardiogram obtained in July 2024 demonstrating complete resolution of previously observed pericardial effusion.

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  Figure 3. Readmission Imaging Demonstrating Recurrent Pericardial Effusion With Tamponade Physiology (A) Chest radiograph obtained during the October 2024 admission showing marked enlargement of the cardiac silhouette. (B) Transthoracic echocardiogram obtained in October 2024 showing a large pericardial effusion anterior to the right ventricle measuring approximately 3 cm with fibrinous material. Echocardiographic findings were consistent with tamponade physiology.

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  Figure 4. Pathologic Findings of Right Atrial Angiosarcoma (A) Histopathologic examination of the resected tumor demonstrating a vasoformative spindle cell neoplasm infiltrating the pericardium (upper right; hematoxylin and eosin stain). (B) Immunohistochemical staining showing strong expression of the endothelial cell marker E26 transformation specific-related gene (ERG) in the neoplastic cells. (C) Gross photograph of the postmortem explanted heart demonstrating residual sarcoma in the right atrium (arrow) surrounding the atrial patch (arrowhead).

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  Figure 5. Pulmonary Metastases from Cardiac Angiosarcoma (A) Gross photographs of lung specimens obtained at postmortem examination demonstrating multiple subpleural and intraparenchymal metastatic nodules (arrowheads) involving all pulmonary lobes. (B) Histopathologic examination of subpleural pulmonary nodules showing metastatic angiosarcoma invading the pulmonary parenchyma and obliterating a large intrapulmonary vessel (hematoxylin and eosin stain).

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  Visual Summary. Clinical Presentation, Diagnostic Evaluation, Imaging Findings, and Management From Initial Presentation Through Postmortem Diagnosis of Cardiac Angiosarcoma AFAB = assigned female at birth; BNP = B-type natriuretic peptide; CRP = C-reactive protein; CT = computed tomography; ECG = electrocardiogram; ESR = erythrocyte sedimentation rate; TTE = transthoracic echocardiography.