Spontaneous synchronous bilateral hemothorax as the only finding in primary pleural angiosarcoma: a case report and a literature review

Abstract

Angiosarcoma is a rare malignancy of vascular origin, mostly originating from skin, soft tissues, and breast, but rarely also from the pleura. We present the case of a 55-year-old man who referred to our hospital for a spontaneous bilateral hemothorax. The CT angiography did not show any source of active bleeding; plus, no pleural or lung masses were observable. Cytological and microbiological analyses made on a sample of pleural fluid resulted negative. Despite numerous blood transfusions and thoracenteses, the patient deceased from hemorrhagic shock ten days later and the diagnosis of primary pleural epithelioid angiosarcoma was obtained only by autopsy. Additionally, we present a review of the literature about primary pleural angiosarcomas.

Pleural Neoplasms—What Could MRI Change?

“…Angiosarcoma can affect several organs [ 45 , 46 ] and usually appears in the pleura as a metastasis from other tissues [ 47 ]. Primary pleural angiosarcoma (PPA) is extremely rare and displays heterogeneous clinical presentation [ 45 , 46 , 47 ]. The diagnosis is usually set based on the biopsy results [ 45 , 48 ].…”

“…The diagnosis is usually set based on the biopsy results [ 45 , 48 ]. The treatment involves surgical resection, radiotherapy, or chemotherapy [ 45 , 46 , 48 ]. Based on the limited number of reported cases, the 2-year survival rate for patients with PPA seems to be around 4.4% with a median overall survival of 4 months [ 48 ].…”

“…PEH is more aggressive than other EH subtypes [ 140 ] and the prognosis in the case of PEH is generally much worse than for pulmonary EH [ 139 ]. The sex and age of the patients could potentially point the physicians in the right direction, as the PEH is more often observed in older men, while the pulmonary EH is primarily observed in young and middle-aged women [ 46 , 47 , 48 ]. Exposure to radiation or to asbestos is considered a risk factor and its confirmation could be helpful in establishing the diagnosis [ 140 ].…”