Usefulness of Multimodality Cardiac Imaging in the Diagnosis of a Right Atrial Angiosarcoma

A 78-year-old woman presented with progressive dyspnea and atrial flutter and was found to have a right atrial mass. Multimodality cardiac imaging was useful in further characterizing this mass, which was ultimately diagnosed after biopsy as a low-grade angiosarcoma.

Case Report

A 78-year-old woman presented to Saint Luke’s Mid America Heart Institute with a several week history of progressive dyspnea on exertion that was associated with occasional hemoptysis and intermittent chest pain, atypical for angina. An initial electrocardiogram revealed atrial flutter. The physical examination results were unremarkable.

A computed axial tomographic angiogram of the chest showed no evidence for pulmonary embolus but did reveal an infiltrative soft tissue mass encasing the right atrium ( Figure 1 ). A transesophageal echocardiogram confirmed a large mass extending from the right atrial appendage into the right atrium, consistent with either thrombus or tumor ( Video 1 ). Positron emission tomography was performed to assess for metabolic activity and revealed evidence for hypermetabolism ( Figure 2 ), consistent with malignancy.

Figure 1

Intravenous contrast-enhanced computed tomography scan with coronal multiplanar reconstruction through the anterior aspect of the heart. An infiltrative mass with nodular contours and heterogeneous contrast enhancement ( white arrow ) is seen encasing the right atrium.

Figure 2

Positron emission tomography/computed tomography fusion image reconstructed in coronal planes corresponding with computed tomography imaging through the right atrium seen in Figure 1 . Hypermetabolic uptake of fluoro-deoxy-glucose-18 ( white arrow ) on positron emission tomography measures 9.8 standardized uptake value maximally and corresponds to the infiltrative soft tissue mass within the wall of the right atrium.

The patient ultimately underwent open right atrial biopsy; pathologic analysis revealed a low-grade angiosarcoma ( Figures 3 and 4 ). Because of infiltration within the right atrial wall, complete resection was not possible, and unfortunately, no effective chemotherapeutic regimens are available.

Jun 16, 2018 | Posted by in CARDIOLOGY | Comments Off on Usefulness of Multimodality Cardiac Imaging in the Diagnosis of a Right Atrial Angiosarcoma

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