Cardiac Angiosarcoma Presenting as Right Heart Failure Secondary to Pulmonary Vascular Carcinomatosis

Angiosarcoma is a rare tumor, representing less than 2% of all soft tissue sarcomas.1 Information about its clinical features is limited.It usually affects adults and can develop from the endothelium of lymphatics or blood vessels. Case ReportA 29-year-old male nonsmoker presented initially to his family physician with a febrile illness and vague retrosternal pain, which was treated with a course of oral antibiotics as a possible acute bronchitis.The patient's condition did not improve and he developed anorexia, progressive weight loss, progressive dyspnea, dry cough, lower limb swelling, and right-sided abdominal pain.He was referred to our hospital for further management six weeks after his initial presentation.On admission, the patient was apyretic with severe respiratory distress.Respiratory rate was 50/min., heart rate 120/min.regular, and blood pressure was 100/60.He was cyanosed with lower limb edema and mild jaundice.There was no clubbing or palpable lymph nodes, but jugular venous pressure (JVP) was elevated.Breath sounds were diminished, with coarse inspiratory crackles in the mid and lower zones bilaterally.Right-sided S3 gallop was audible, but there were no murmurs or pericardial rub.The patient had some tenderness in the right hypochondrium, but no palpable organomegaly.He had no clinical signs of superior or inferior vena caval obstruction, and the rest of the examination was normal.Chest x-ray showed confluent nodular infiltrates throughout the lung fields, with a globular bulge at the right heart border (Figure 1).Electrocardiogram showed sinus tachycardia, with nonspecific T-wave changes.Arterial blood gases on 6-liter nasal cannula showed: pH 7.52; P 02 53; PC02 24; and HC03 20.5.Blood tests showed mild impairment of liver function, but were otherwise nonspecific.Transthoracic echocardiogram was done but it was suboptimal and technically difficult, as the patient was unable to stay supine.The study showed a