Weekly Chest CasesArchive of Old Cases

Case No : 220 Date 2002-01-12

  • Courtesy of In Sun Lee, M.D., Jin Seong Lee, M.D., Koun-Sik Song, M.D. / Asan Medical Center, Seoul, Korea
  • Age/Sex 20 / M
  • Chief ComplaintDyspnea on exertion
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Primary Cardiac Angiosarcoma
Radiologic Findings
Chest radiograph shows mild cardiomegaly. MR images obtained at the ventricular level show an infiltrative mass along the free wall of the right atrium and ventricle. The mass is seen as a high signal intensity on double inversion recovery and triple inversion recovery images as well as diffuse enhancement upon contrast injection. On the follow-up CT obtained 2months later, the mass has increased in size and number, and variable sized metastatic lung nodules have developed.
The diagnosis of angiosarcoma was made by transthoracic needle biopsy for the metastatic lung nodule.
Brief Review
Angiosarcoma is the most common cardiac sarcoma in surgical studies (37% of cases) (1-3). These tumors are typically occur in middle-aged men; because the tumor tends to occur in the right atrium and involves the pericardium, patients usually present with right-sided heart failure or tamponade. Pathologically, two main morphologic types have been reported: a well-defined mass protruding into a cardiac chamber, usually the right atrium, and a diffusely infiltrative mass extending along the pericardium. CT demonstrates a low attenuated right atrial mass, which may be irregular or nodular and usually arises from the right atrial free wall, or pericardial effusion or thickening due to obliteration of pericardial space by hemorrhagic, necrotic tumor debris. MR imaging demonstrates a local nodular areas of increased signal intensity interspersed within areas of intermediate signal intensity on T1-weighted and T2-weighted images. Linear contrast material enhancement along vascular lakes is shown in cases with diffuse pericardial infiltration.
References
1. Burke AP, Virmani R. Tumors of the heart and great vessels. In: Atlas of tumor pathology. Fasc 16, ser 3. Washington DC: Armed Forces Institute of Pathology, 1996
2. Mary LG, Melissa L, Allen PB, et al. Primary cardiac and pericardial neoplasms radiologic-pathologic correlation. Radiographics 2000; 20:1073-1103
3. McCallister HA. Tumors of the heart and pericardium. Curr Probl Cardiol 1979; 4:1-51
Keywords
Vascular, Malignant tumor,

No. of Applicants : 19

▶ Correct Answer : 9/19,  47.4%
  • - Ansung Public Health Center, Korea Joon Woo Lee
  • - Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
  • - CHU Nancy-Brabois, France Denis Regent
  • - Harasanshin hospital, Fukuoka, Japan Shunya Sunami
  • - Korea Cancer Center Hospital, Korea Donghee Park
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Samsung Medical Center, Korea Young Cheol Yoon
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Sungji Hospital, Korea Jung Hee Kim
▶ Semi-Correct Answer : 4/19,  21.1%
  • - Gochang Hospital, Korea Jiyong Rhee
  • - Inha University Hospital, Korea Dong-Jae Shim
  • - MH[CTC] PUNE, INDIA Vivek Sharma
  • - Pulmonary Medicine Doctor, Korea Jae-Joon Yim
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