Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão

Abstract

We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti- inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE). After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent videothoracsopy which diagnosed cardiac angiosarcoma with pulmonary metastisation. Within a few days there was a rapid evolution of the clinical picture, with cardiac failure and death of the patient without radiotherapy or adjuvant chemotherapy being started.

State of the art paper Sarcomas of the heart as a difficult interdisciplinary problem

“…Correct and prompt diagnosis of malignant tumors of the heart is extremely important. Unfortunately, there is still a significant rate of false diagnoses and inappropriate therapy being conducted [12, 19, 126]. This clearly indicates the need to broaden diagnostics with transoesophageal echocardiography in each cardiological and cardiosurgical case that remains even slightly ambiguous [14].…”

“…In the majority of cases the pericardium is involved and pericardial effusion observed, mostly hematic [10, 11]. In the literature there are numerous reports of angiosarcoma clinical manifestations in the form of: pericarditis [9, 12, 13], valvular dysfunction [14, 15], coronary artery disease [13], tamponade [16–18], cardiomyopathy, and even heart rupture (7 cases) [19]. Angiosarcoma can imitate pulmonary embolism [15] or a myxoma [20] and even grow within the interventricular septum [21].…”