Key Points
- To describe the successful diagnosis and nonsurgical management of a primary cardiac angiosarcoma using transvenous endomyocardial biopsy guided by transesophageal echocardiography and rapid on-site cytology.
- Evaluated a 57-year-old female presenting with dyspnea, left back pain, a right atrial mass invading the right coronary artery, and metastatic liver tumors using CT, angiography, and echocardiography.
- Performed transvenous endomyocardial biopsy under transesophageal echocardiographic guidance and intra-procedural fast smear cytology following an unsuccessful fluoroscopy-guided attempt.
- Analyzed harvested tissue with hematoxylin-eosin and immunohistochemical staining for anti-factor VIII antigen, CD31, and CD34, followed by systemic docetaxel chemotherapy and radiation.
- Immunohistochemical staining confirmed spindle-shaped cells positive for CD31, CD34, and anti-factor VIII antigen, confirming primary cardiac angiosarcoma.
- Follow-up CT scans demonstrated a reduction in cardiac tumor size three months after beginning chemotherapy and radiotherapy.
Structured PICO
PPopulationA 57-year-old female presenting with shortness of breath and left back pain, found to have a large mass in the right atrium (maximum diameter 50 mm) and multiple liver tumors.
IInterventionTransvenous endomyocardial biopsy with the aid of transesophageal echocardiography (TEE) and intra-procedural consultation (fast smear cytology).
OOutcomeHistological diagnosis of the cardiac tumor.
TEE-guided transvenous endomyocardial biopsy combined with intra-procedural fast smear cytology is a safe and effective method for diagnosing cardiac tumors, particularly when open surgical biopsy poses high risks.