Intracardiac Echocardiography-Guided Biopsy for a Giant Cardiac Angiosarcoma with Extensive Invasion

Cardiac angiosarcoma is a rare malignant tumor with a poor prognosis. Because of its aggressive nature, early pathological diagnosis is essential. Previous studies have reported the efficacy of intracardiac echocardiography (ICE) -guided biopsy for unknown cardiac masses; however, its application is unclear. Herein, we describe a case of a giant cardiac angiosarcoma with extensive invasion, successfully diagnosed using ICE-guided biopsy. A 52-year-old man with palpitations and facial edema was admitted to our hospital. Contrast-enhanced computed tomography (CT) revealed a giant hypervascular tumor in the right atrium, extending into nearby structures, including the interatrial septum and left atrial roof. The tumor was initially suspected to be either a mediastinal tumor with cardiac invasion or a primary cardiac tumor. Given the high bleeding risk associated with percutaneous CT-guided or thoracoscopic biopsies, an ICE-guided biopsy of the right atrial mass was performed using a steerable sheath, without complications. The patient was diagnosed with angiosarcoma and underwent surgical resection. Intra-operative evaluation revealed that the tumor was confined to the pericardium with no mediastinal invasion, confirming the diagnosis of primary cardiac angiosarcoma. The patient underwent postoperative chemotherapy and radiotherapy, and is alive 7 months after surgery, demonstrating that ICE-guided biopsy using a steerable sheath is a safe and effective diagnostic tool for cardiac masses, particularly those with malignant characteristics and extensive invasion.