Key result
Chemotherapy with docetaxel and gemcitabine failed to control right atrial epithelioid hemangioendothelioma in a single patient, who died from an opportunistic infection 5 months later.
Why the study?
Cardiac epithelioid hemangioendothelioma is very rare, and the radiologic manifestations of diffuse pulmonary nodules with halo signs representing its metastasis are relatively uncommon.
Case Report (n=1)
In cases of bilateral diffuse pulmonary nodules suspicious for cardiac origin, echocardiography alone may be insufficient to exclude an atrial mass, highlighting the utility of cardiac CT or MRI.
Echocardiography may miss cardiac masses despite pulmonary metastases; case reports leave open optimal imaging strategies for rare EHE.
Cardiac epithelioid hemangioendothelioma (EHE) is a very rare tumour of endothelial origin with the lung and liver as the most easily metastatic organs. We describe herein a patient with hemoptysis, severe anaemia, and diffuse pulmonary nodules with halo signs that represented metastasis of cardiac EHE; these radiologic manifestations are relatively uncommon. During the initial workup for the patient’s pulmonary nodules, echocardiography missed the cardiac mass. However, positron emission tomography‐computed tomography revealed increased fluorodeoxyglucose intake in the right atrial wall, and cardiac magnetic resonance imaging (MRI) revealed an irregular nodule with normal T1‐weighted signal intensity and hyperintense T2‐weighted signal intensity. Enhanced abdominal computed tomography (CT) revealed micronodular liver metastases. Video‐assisted thoracic surgery was performed to make a definitive diagnosis. Immunohistochemistry staining proved the diagnosis of EHE with positive results for cluster of differentiation (CD) 34, CD31, erythroblast transformation‐specific‐related gene and Ki‐67. The patient started chemotherapy with docetaxel (75 mg/m2) and gemcitabine (900 mg/m2), but this failed to control his disease and he died from an opportunistic infection related to his immunocompromised status 5 months later. For the work out process of bilateral diffuse pulmonary nodules suspicious for cardiac origin, especially with atrial deviation, echocardiography alone is not sufficient to exclude atrial origin. Cardiac CT or MRI might be a better choice.
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Zhou et al. (2019) conducted a case report in Cardiac epithelioid hemangioendothelioma (n=1). Chemotherapy with docetaxel and gemcitabine was evaluated. Chemotherapy with docetaxel and gemcitabine failed to control right atrial epithelioid hemangioendothelioma in a single patient, who died from an opportunistic infection 5 months later.
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