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Magnetic resonance image of a large, fatal angiosarcoma of the heart

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A 49 year old man underwent kidney transplantation. Because of an initial rejection of the allograft the usual doses of azathioprine and steroids were increased. Three years later the patient developed atrial fibrillation and clinical features of pericarditis. An echocardiogram showed a right atrial mass which was confirmed by computed tomography. Magnetic resonance imaging with gadolinium injection revealed the true extent of the tumour and indicated a diagnosis of angiosarcoma of the heart (below left, arrows show the tumour invading the interventricular septum, right atrium and right ventricle walls; below right, arrows show the reduction of the right atrium and involve

ment of the atrioventricular septum by the expansive mass). Because of major involvement of the cardiac structures it was decided to initiate chemotherapy. However, because of a refractory heart and renal failure, the patient died in the following month. The diagnosis was confirmed by necropsy, histology, and electron microscopy.

Angiosarcoma is a rare tumour of the heart and has a poor prognosis. In our case the extent of the tumour was exceptional and accounts for the rapid death of the patient. Magnetic resonance imaging with gadolinium injection appears to be the imaging modality of choice for an early diagnosis of malignant heart tumours.