Ruptured cardiac angiosarcoma with pulmonary metastases: A rare disease with a common (mis)diagnosis!

Jain, Gaurav; Mukhopadhyay, Saibal; Kurien, Sumod; Yusuf, Jamal; Tyagi, Sanjay; Jain, Rajat

doi:10.1016/j.ihj.2012.07.016

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…However, cardiac rupture related to angiosarcoma is extremely rare and only a few cases have been reported in the literature. [3,4] It is a very fatal complication that can lead to sudden cardiac death. The patient of our case showed rupture of the right cardiac wall caused by direct tumor invasion at her second hospital visit and she survived fortunately.…”

Section: Discussionmentioning

confidence: 99%

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Primary cardiac angiosarcoma with right atrial wall rupture

Kim¹,

Nam²,

Hwang³

et al. 2019

Medicine

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Rationale: Cardiac angiosarcoma is the most common malignant tumor of the heart and a rare disease with rapid disease progression and poor prognosis. Cardiac wall rupture is an extremely rare complication. Patient concerns: A 32-year-old woman presented with an acute onset of epigastric pain and chest discomfort at first time when she visited an emergency room. Diagnoses: A cardiac mass was identified on echocardiography and subsequently performed chest computed tomography and cardiac magnetic resonance imaging revealed the cardiac tumor at right atrium with right atrial wall rupture and hematogenous lung metastasis. Histopathologic diagnosis of metastatic angiosarcoma was done by open lung biopsy. Interventions: The patient was treated with palliative chemotherapy for the primary cardiac tumor and hematogenous lung metastasis. Outcomes: The follow-up imaging studies revealed treatment response of the primary cardiac tumor and hematogenous lung metastasis. Lessons: Clinical and radiologic evaluation of the cardiac angiosarcoma was well performed in our case with various diagnostic imaging modalities including echocardiography, chest computed tomography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography/computed tomography. This case report well demonstrates typical imaging findings of a rare cardiac tumor and emphasizes importance of early investigation for accurate diagnosis and proper management of the cardiac tumor.

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Section: Discussionmentioning

confidence: 99%

“…Only a few cases have been reported in the literature. [3,4] Early diagnosis is challenging because of non-specific symptoms and rarity of the disease. However, advances in imaging modality improved early detection of cardiac tumor and can be beneficial for proper management.…”

Section: Introductionmentioning

confidence: 99%

Primary cardiac angiosarcoma with right atrial wall rupture

Kim¹,

Nam²,

Hwang³

et al. 2019

Medicine

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“…[6] Infection is yet another common misdiagnosis, particularly tuberculosis in China or India, where the morbidity of tuberculosis is relatively high. [8] For patients with concurrent hemoptysis and cardiac dysfunction, Behçet disease is also a potential misdiagnosis. Misdiagnosis often delays the actual diagnosis, which results in a higher risk of biopsy and lower chance of oncologic treatment; some patients have even lost the chance for diagnosis while still alive.…”

Section: Discussionmentioning

confidence: 99%

“…MRI and transesophageal echocardiography could be more promising because of their higher resolution and sensitivity. [8,21] MRI is useful in detecting the tumor and depicting its contour and relationship with other cardiac structures. [21] MRI with gadolinium enhancement could provide more useful information for the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are often initially misdiagnosed because of the nonspecific clinical manifestation and low clinical suspicion for the disease, which often leads to late diagnosis and a poorer prognosis. Some patients fail to be diagnosed while they are alive [2,7,8] ; in fact, most patients are diagnosed at autopsy. [6,9] Several case reports and small series have described patients with angiosarcoma in the lung (primary or metastatic).…”

Section: Introductionmentioning

confidence: 99%

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Clinical and diagnostic features of angiosarcoma with pulmonary metastases

Wang¹,

Shi²,

Liu³

et al. 2017

Medicine

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Angiosarcoma with pulmonary metastasis is a rare, fatal disease that often presents with multiple pulmonary nodules and diffuse alveolar hemorrhage. We herein review the detailed clinical characteristics of pulmonary metastatic angiosarcoma and determine a reasonable diagnostic strategy.The medical records of 11 patients with pulmonary angiosarcoma were reviewed.The mean age of the patients was 45.7 years (range, 30-71 years). All patients were male. The most common symptom was hemoptysis (8/11). Common initial misdiagnoses were tuberculosis (5/11), vasculitis (2/11), nontuberculous infectious disease (1/11), and constrictive pericarditis (1/11). Chest computed tomography (CT) of patients with hemoptysis showed bilateral, randomly distributed, variably shaped, and differently sized nodules, as well as ground-glass opacities (GGO) (8/11). The right heart was the most common primary tumor site (8/11), but the sensitivity of echocardiography was limited; CT angiography and cardiac magnetic resonance imaging (MRI) revealed more atrial masses. CT-guided needle biopsy was difficult to perform in most patients because of the small size of the nodules. The diagnosis was made by surgical biopsy of either the lung (3/9) or heart (6/9). The median overall survival of patients who underwent lung biopsy and those who underwent cardiac/pericardiac biopsy was 4.1 and 1.4 months, respectively (P = .098). The median overall survival of the 9 available patients was 5.0 months (95% confidence interval, 0.500-8.544).Angiosarcoma with pulmonary metastases should be considered in patients with hemoptysis and concurrent GGO and nodules on their chest CT scan. Careful cardiologic monitoring is necessary for these patients, even without any cardiac symptoms or signs, and enhanced cardiac MRI is the first recommendation. Surgical biopsy is reliable for histological diagnosis, but the safety of the lung biopsy should be carefully assessed. When primary cardiac tumors are identified, heart biopsy should be preferentially considered.

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