A 36 year old woman presented with syncope and was found to have hemorrhagic pericardial effusion.
Images from her initial chest CT:
CT images show a moderate pericardial effusion and wall thickening of the right atrium. It’s unclear from these initial images whether this represents a solid mass or thickened trabeculae with outpouching of the right atrial lumen. A subsequent PET/CT scan showed intense FDG uptake in the right atrial wall, suggesting a solid mass.
A cardiac MRI exam confirms a solid mass involving the anterior aspect of the right atrial wall, adherent to the pericardium and separate from the SVC/IVC inflow tracts.
Dynamic post-contrast imaging demonstrates early avid enhancement of the right atrial mass.
This patient was diagnosed with cardiac angiosarcoma.
A rare malignancy overall, cardiac angiosarcoma is the most common primary malignancy of the heart. This tumor often occurs in middle age and is slightly more common in men. There is a propensity to involve the right atrium and pericardium, and as a result patients may present with right heart failure or pericardial effusion/tamponade (which is often hemorrhagic). This tumor has a poor prognosis, with a majority of cases metastatic at presentation and median survival in the range of 6 months-3 years. Araoz PA, et al. Radiographics 1999;16:1421-34.