• Images in cardiology

A 48 year old man visited our hospital because of fatigue. Transthoracic echocardiography demonstrated a capsulated mass in the pericardial space with pericardial effusion. Doppler flow velocity signal during diastole was detected, indicating epicardial left coronary artery running into the tumour (upper panel). This finding suggested that arteries were running from the coronary artery to feed the tumour, most likely an angiosarcoma. Thus, the patient was hospitalised immediately. Pericardial fluid containing blood was collected by pericardiocentesis but was cytologically negative for malignant cells. Enhanced computed tomography (CT) scan revealed a tumour measuring 14 × 10 cm of inhomogeneous density compressing the left ventricle. Gated cardiac magnetic resonance imaging showed an extensive mass of heterogeneous signal intensity in the pericardial space (lower left panel). A coronary angiogram revealed a massive supply artery from the left coronary artery to the tumour with contrast retention (lower right panel).

Histological examination of the open chest biopsy samples showed multiple anastomosing vascular channels lined with malignant endothelial cells, comparable with angiosarcoma. Surgical resection and irradiation were not applicable. Chemotherapy with adriamycin, cyclophosphamide, and dacarbazine was prescribed, but the patient died 12 months after the initiation of the treatment.

Angiosarcoma are usually diagnosed postmortem. Both clinical course and physical examination are non-specific. If time and cost do not matter, enhanced CT or magnetic resonance imaging could offer more precise and detailed information than echocardiography. However, non-invasive, prompt, and less expensive imaging techniques are required on a daily outpatient basis. Doppler flow velocity imaging seems to be useful for the earlier diagnosis of cardiac angiosarcoma.

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