대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

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,