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Cardiac Angiosarcoma : Clinical Features

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Clinical Features: Cardiac angiosarcomas show a male predilection and the average age at presentation is below 65 years. The presenting symptoms are non-specific and vague and the diagnosis is often delayed until the patient has developed advanced disease or metastasis. The most common presentation is with chest pain, shortness of breath, and fatigue.

Diagnosis: Diagnosis is made by imaging studies. Echocardiography is the most sensitive method and shows an echogenic lobular mass, usually in the right atrium. There may be associated hemopericardium. CT with contrast shows enhancement with vascular lakes and there may be evidence of metastases. Endomyocardial biopsy is not recommended due to high false negative rates (about 50% of cases).

Case History The patient was a young male who presented with fatigue and shortness of breath. A chest CT revealed a large right atrial mass which was resected. The gross specimen had multiple soft, red hemorrhagic nodules interspersed with necrotic areas. This image shows a hemorrhagic tumor with gaping vascular channels (left) infiltrating the right atrial wall (right).

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