A 61-year-old man diagnosed with metastatic cardiac angiosarcoma presenting as a 48.5 x 60.5 x 61 mm right atrial mass rapidly deteriorated and died on hospital day 8.
Case Report (n=1)
This case highlights the diagnostic challenge of cardiac angiosarcoma, emphasizing the need for multimodality imaging when symptoms mimic common infectious processes.
Abstract Cardiac angiosarcoma is a rare and aggressive malignancy, often presenting with nonspecific cardiopulmonary symptoms that mimic common infections such as pneumonia, bronchitis, or endocarditis. It grows rapidly, metastasizes early, and frequently involves multiple organs before diagnosis, which contributes to a poor prognosis. Awareness of this tumor’s atypical presentations is critical to avoid delays in diagnosis. We present a 61-year-old man with PTSD, osteoarthritis, hyperlipidemia, and GERD who was admitted with progressive shortness of breath, tachycardia, and altered mentation. He had a recent dental extraction complicated by abscess formation requiring debridement. Initial chest imaging suggested bilateral pulmonary infiltrates, raising concern for pneumonia. CTA of the chest, abdomen, and pelvis revealed a lobulated right atrial mass measuring 48.5 × 60.5 × 61 mm, with moderate four-chamber cardiac enlargement and straightening of the interventricular septum. There were extensive bilateral ground-glass opacities, dense consolidations in both lower lobes, and small scattered pulmonary nodules. The liver contained numerous hypoattenuating lesions with heterogeneous enhancement, consistent with metastatic disease. Transthoracic echocardiography confirmed a mass involving the interatrial septum and RV free wall, along with moderate pericardial effusion. Blood cultures were negative, and empiric broad-spectrum antibiotics were administered. Liver biopsy performed on hospital day 2 confirmed metastatic cardiac angiosarcoma. Despite supportive care, the patient developed acute respiratory failure requiring intubation on hospital day 6 and passed away on hospital day 8. This case illustrates the diagnostic challenge of cardiac angiosarcoma, which often mimics infectious or inflammatory conditions. Key “red flags” include a large right atrial mass, unexplained pulmonary nodules, pericardial effusion, and multiorgan lesions. The aggressive nature of this tumor, combined with early hematogenous spread, frequently results in rapid clinical deterioration. Multimodality imaging, including CTA and echocardiography, is essential for identifying cardiac masses, while histopathologic confirmation remains the gold standard. Clinicians should maintain a high index of suspicion in patients with unexplained cardiopulmonary symptoms and multiorgan involvement. Primary cardiac angiosarcoma is a rare but highly aggressive malignancy. Early recognition of imaging and clinical patterns can guide diagnosis and management, although prognosis remains poor once metastatic disease is present. This case underscores the importance of considering rare cardiac malignancies when symptoms and imaging findings are atypical or do not fully align with common infectious processes. This abstract is funded by: None
Thakkar et al. (Fri,) conducted a case report in Metastatic cardiac angiosarcoma (n=1). Supportive care and empiric broad-spectrum antibiotics was evaluated. A 61-year-old man diagnosed with metastatic cardiac angiosarcoma presenting as a 48.5 x 60.5 x 61 mm right atrial mass rapidly deteriorated and died on hospital day 8.