Concomitant intravascular and extravascular obstructive shock: a case report of cardiac angiosarcoma presenting with pericardial tamponade

Abstract

Atraumatic pericardial tamponade and intracardiac masses are both recognized etiologies of acute obstructive shock. Pericardial tamponade, is a cardiovascular emergency commonly considered by emergency physicians and, as a result, evaluation for this process has been incorporated into standardized point of care ultrasound algorithms for assessing hypotension. Obstructive shock secondary to intracardiac tumors is an atypical clinical presentation, and although it is evaluated by the same ultrasound imaging modality, it is generally not considered or evaluated for in the emergency department setting. The concomitant presentation of these two pathologic processes is an extremely rare oncologic emergency. Existing literature on the subject is found in a small number of case reports with nearly no prior descriptions in emergency medicine references. In the right clinical context this unique presentation should be considered and evaluated for in the emergency department via point of care ultrasound modality to help guide in the management of the resulting obstructive shock.

Primary Cardiac Angiosarcoma With Pulmonary Metastasis in a Young Female: A Case Report and Review of Literature

“…The most prevalent symptoms were dyspnea, chest pain, tachycardia, pleural and pericardial effusion (7,(14)(15)(16)(17)(18)(19). There were also cases presented with left atrium mass (20,21), ascites (16), SVC involvement (8, 19,22,23), valvular complications (18, 20), tamponade and shock (24,25), involvement of coronary vessels (26, 27), or heart rhythm abnormalities (20). In our patient, a rupture in the atrial wall was discovered which was assumed to be the underlying cause for her symptoms.…”