Radiology Case Reports Volume I, Issue 4, 2006
Cardiac Angiosarcoma on CT Dhawal Goradia, Felix S. Chew Among cardiac masses, primary malignant neoplasms are very rare. Here we describe a case of primary cardiac angiosarcoma on computed tomography (CT).
Case Report A 33-year-old man presented with chest pain, shortness of breath, cough and hemoptysis and underwent contrastenhanced CT of the chest for further evaluation (Figure 1). The patient went on to operative excision of the mass. Histopathologic evaluation of the mass revealed high grade angiosarcoma. Discussion Among cardiac tumors, metastases are much more common than primary cardiac tumors (1). Typical primary sources include bronchogenic carcinoma, breast carcinoma, melanoma, and lymphoma (1, 2). Metastases may involve the heart by contiguous extension (often from the lung) or by lymphatic or hematogenous dissemination (3). Primary cardiac tumors are much less common, estimated to be 100-1000 times less prevalent than metastases (4). The most common primary cardiac tumor is a benign myxoma, the majority of which are found in the left atrium (5). Sarcomas as a group are the second most common primary cardiac tumors, of which angiosarcoma is the most common cell type (4, 6). Angiosarcomas affect adults and are twice as common in men as in women (4, 7). 80% of cardiac angiosarcomas occur in the right atrium and involve the pericardium and therefore, patients commonly present with right
Figure 1A. 33-year-old man with chest pain, hemoptysis, and right atrial mass. Axial CT section through the chest after intravenous contrast, mediastinal window shows a filling defect in the right atrial lumen that extends across the adjacent wall of the right atrium into the epicardial fat. There is also a moderate sized pericardial effusion.
heart failure or tamponade (4, 7). The most common site of metastasis for angiosarcoma is the lung (7). Angiosarcomas tend to be large hemorrhagic right atrial masses that may replace the right atrial wall, and may extend into the adjacent cardiac chamber (4, 8). In this case, the invasive appearance of the mass and the presence of pulmonary metastases excludes thrombus and benign lesions from the differential diagnosis. The two most reasonable diagnostic possibilities are cardiac metastasis from an extracardiac primary versus primary cardiac sarcoma, with the former being statistically far more common.
Citation: Goradia D, Chew FS. Cardiac angiosarcoma on CT. Radiology Case Reports. [Online] 2006;1:45. Copyright: © Dhawal Goradia. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License, which permits reproduction and distribution, provided the original work is properly cited. Commercial use and derivative works are not permitted. Abbreviations: CT, computed tomography Dhawal Goradia (Email: [email protected]) and Felix Chew are from the University of Washington, Department of Radiology, Seattle, WA, United States of America. DOI: 10.2484/rcr.v1i4.45
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Cardiac Angiosarcoma on CT
Figure 1B. 33-year-old man with chest pain, hemoptysis, and right atrial mass. Axial CT section through the chest, lung window demonstrates multiple bilateral small pulmonary nodules.
References 1. Lam KY, Dickens P, Chan ACL. Tumors of the heart: a 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med 1993; 117:1027-1031. [PubMed] 2. Klatt EC, Heitz DR. Cardiac metastases. Cancer 1990; 65:1456-1459. [PubMed] 3. Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic Involvement of the Heart and Pericardium: CT and MR Imaging. Radiographics 2001; 21: 439. [PubMed] 4. Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics. 2000; 20(4):1073-103. [PubMed] 5. Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR. Cardiac myxoma: imaging features in 83 patients. Radiographics. 2002; 2(3):673-89. [PubMed] 6. Burke AP, Cowan D, Virmani R. Primary sarcomas of the heart. Cancer 1992; 69:387-395. [PubMed] 7. Janigan DT, Husain A, Robinson NA. Cardiac angiosarcomas: a review and a case report. Cancer 1986; 57:852-859. [PubMed] 8. Araoz PA, Eklund HE, Welch TJ, Breen JF. CT and MR imaging of primary cardiac malignancies. Radiographics. 1999; 19(6):1421-34. [PubMed]
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2006:1(4):126-127
Cardiac Angiosarcoma on CT Dhawal Goradia, Felix S. Chew Among cardiac masses, primary malignant neoplasms are very rare. Here we describe a case of primary cardiac angiosarcoma on computed tomography (CT).
Case Report A 33-year-old man presented with chest pain, shortness of breath, cough and hemoptysis and underwent contrastenhanced CT of the chest for further evaluation (Figure 1). The patient went on to operative excision of the mass. Histopathologic evaluation of the mass revealed high grade angiosarcoma. Discussion Among cardiac tumors, metastases are much more common than primary cardiac tumors (1). Typical primary sources include bronchogenic carcinoma, breast carcinoma, melanoma, and lymphoma (1, 2). Metastases may involve the heart by contiguous extension (often from the lung) or by lymphatic or hematogenous dissemination (3). Primary cardiac tumors are much less common, estimated to be 100-1000 times less prevalent than metastases (4). The most common primary cardiac tumor is a benign myxoma, the majority of which are found in the left atrium (5). Sarcomas as a group are the second most common primary cardiac tumors, of which angiosarcoma is the most common cell type (4, 6). Angiosarcomas affect adults and are twice as common in men as in women (4, 7). 80% of cardiac angiosarcomas occur in the right atrium and involve the pericardium and therefore, patients commonly present with right
Figure 1A. 33-year-old man with chest pain, hemoptysis, and right atrial mass. Axial CT section through the chest after intravenous contrast, mediastinal window shows a filling defect in the right atrial lumen that extends across the adjacent wall of the right atrium into the epicardial fat. There is also a moderate sized pericardial effusion.
heart failure or tamponade (4, 7). The most common site of metastasis for angiosarcoma is the lung (7). Angiosarcomas tend to be large hemorrhagic right atrial masses that may replace the right atrial wall, and may extend into the adjacent cardiac chamber (4, 8). In this case, the invasive appearance of the mass and the presence of pulmonary metastases excludes thrombus and benign lesions from the differential diagnosis. The two most reasonable diagnostic possibilities are cardiac metastasis from an extracardiac primary versus primary cardiac sarcoma, with the former being statistically far more common.
Citation: Goradia D, Chew FS. Cardiac angiosarcoma on CT. Radiology Case Reports. [Online] 2006;1:45. Copyright: © Dhawal Goradia. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License, which permits reproduction and distribution, provided the original work is properly cited. Commercial use and derivative works are not permitted. Abbreviations: CT, computed tomography Dhawal Goradia (Email: [email protected]) and Felix Chew are from the University of Washington, Department of Radiology, Seattle, WA, United States of America. DOI: 10.2484/rcr.v1i4.45
RCR Radiology Case Reports | radiology.casereports.net
126
2006:1(4):126-127
Cardiac Angiosarcoma on CT
Figure 1B. 33-year-old man with chest pain, hemoptysis, and right atrial mass. Axial CT section through the chest, lung window demonstrates multiple bilateral small pulmonary nodules.
References 1. Lam KY, Dickens P, Chan ACL. Tumors of the heart: a 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med 1993; 117:1027-1031. [PubMed] 2. Klatt EC, Heitz DR. Cardiac metastases. Cancer 1990; 65:1456-1459. [PubMed] 3. Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic Involvement of the Heart and Pericardium: CT and MR Imaging. Radiographics 2001; 21: 439. [PubMed] 4. Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics. 2000; 20(4):1073-103. [PubMed] 5. Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR. Cardiac myxoma: imaging features in 83 patients. Radiographics. 2002; 2(3):673-89. [PubMed] 6. Burke AP, Cowan D, Virmani R. Primary sarcomas of the heart. Cancer 1992; 69:387-395. [PubMed] 7. Janigan DT, Husain A, Robinson NA. Cardiac angiosarcomas: a review and a case report. Cancer 1986; 57:852-859. [PubMed] 8. Araoz PA, Eklund HE, Welch TJ, Breen JF. CT and MR imaging of primary cardiac malignancies. Radiographics. 1999; 19(6):1421-34. [PubMed]
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2006:1(4):126-127
