Fast growing angiosarcoma of the right atrium after radiofrequency catheter ablation: a missed diagnosis or misdiagnosis case report

Abstract

Background: Primary angiosarcomas of the right atrium are extremely rare, often resulted in missed diagnosis or misdiagnosis with routine examination tools. These malignant cardiac tumors are highly aggressive with generally poor prognosis. Surgical excision is the mainstay of treatment as it is essentially not responsive to current regimens of chemoradiotherapy. Case presentation: Herein, we describe a patient who initially presented with paroxysmal atrial fibrillation and was subsequently treated with radiofrequency catheter ablation (RFCA). Prior to RFCA, an initial transesophageal echocardiography revealed a local thickening of the intratrial septum. Three months later, she was hospitalized with progressive dyspnea and massive pericardial effusion. A large immobile, non-pedunculated mass, occupying almost half of the right atrium was detected by transthoracic and transesophageal echocardiogram. Multimodality cardiac imaging was useful in further characterizing this mass, which was ultimately diagnosed as an angiosarcoma based upon biopsy results. The growth rate was extremely rapid following RFCA, and patient underwent surgical excision. After discharge, the angiosarcoma recurred and patient survived for 7 months from the first episode of tamponade. Conclusions: Primary cardiac angiosarcoma of the right atrium can easily be mistaken for structural anomalies in its early stages, losing the opportunity for initiating earlier treatments to improve potential patient outcomes. The correct diagnosis of this rare case relied on the comprehensive utilization of multimodal imaging techniques including biopsy.

Primary cardiac tumor: a case report of right atrial angiosarcoma and review of the literature

“…Analysis of pericardial fluid does not always show malignant cells even in the presence of pericardial invasion which emphasizes the limited diagnostic value of this test. 14 So, we need to get a tissue sample to determine the nature of the heart mass. We confirm the diagnosis of cardiac angiosarcoma in this case by immunohistochemical staining for endothelial markers, of which CD31 is very sensitive for indicating vascular tumors.…”

“…When the tumor cannot be completely resected, partial resection can relieve the hemodynamic obstruction and alleviate short-term clinical symptoms. 2,14 For the patients with incomplete surgical resection, chemotherapy and radiotherapy are options. Preoperative chemotherapy may decrease tumor bulk and eliminate micrometastasis prior to local tumor excision, which is beneficial for patients with metastatic disease.…”

Clinical Detection of Primary Pulmonary Angiosarcoma

“…As seen in this case, although two months elapsed between initial hospitalization and biopsy, the patient had concerning symptoms for over a year. Misdiagnosis is common in PAS as symptoms are nonspecific and mimic other more common disease processes [ 15 ]. Nonspecific constitutional and respiratory symptoms can include weight loss, shortness of breath, cough, hemoptysis, and chest pain, for which the differential diagnoses encompass more common diseases in various organ systems.…”

Primary Cardiac Epithelioid Angiosarcoma with Sustained Remission following Surgical Resection: A Case Report

“…In published case reports and series of primary cardiac angiosarcoma, patients have presented with chest pain, congestive heart failure, syncope, fatigue, palpitations, and dyspnea. However, there is no consistent symptomatology or specific physical exam findings, making the diagnosis clinically challenging even with advances in diagnostic imaging [ 4 , 5 ]. Due to the nature of its aggressive and high-grade pathology, predilection for early metastasis, and diagnostic challenges, prognosis is poor with a mean survival of nine to 12 months at time of diagnosis [ 6 ].…”