Right atrial rupture due to cardiac angiosarcoma without hemodynamic collapse: a case report of successful multidisciplinary management

Abstract Background Malignant tumors account for approximately 20–30% of primary cardiac tumors, and reports remain rare. Cardiac angiosarcoma is a representative type, but prognosis is extremely poor: the median survival is about 4 months in unresectable cases and 14 months after complete resection.1,2 Approximately 29% of angiosarcomas present with metastasis at diagnosis, and the presence of pericardial effusion suggests pericardial invasion. Evidence regarding chemotherapy remains limited, and no standardized treatment has been established for metastatic primary cardiac tumors. Case Summary We report a case of cardiac angiosarcoma in a 74-year-old man. At the time of presentation, masses were detected in the right atrium and the apex of the left ventricle. The right atrial tumor extended widely along the atrial wall and partially formed fistulous tracts, resulting in direct communication of blood flow from the right atrium into the pericardial cavity. Surgical tumor resection with atrial wall reconstruction was performed, and chemotherapy was initiated following histopathological confirmation. Discussion Due to their poor prognosis, cardiac tumors are often managed with palliative care. This case highlights two important points: first, cardiac angiosarcoma can cause atrial wall destruction and rupture, leading to direct communication between the atrium and pericardial space; second, even in cases of primary cardiac angiosarcoma with pulmonary metastases, appropriate cardiac surgery combined with chemotherapy may improve patient outcomes.