SHM Converge Scientific Abstract ePoster Gallery-Cardiac Angiosarcoma Presenting as Recurrent Idiopathic Pericarditis

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This case report describes a 53-year-old woman with two recent admissions for presumed idiopathic pericarditis who returned with worsening chest pain, shortness of breath, and lightheadedness. Her first admission involved pericardial tamponade requiring urgent pericardiocentesis, but fluid cytology was negative and she was discharged on anti-inflammatory therapy with follow-up imaging.<br /><br />On readmission, cardiac CT, echocardiography, and cardiac MRI identified a lobulated mass near the right atrium that was initially thought to represent thrombus or postoperative hematoma. However, repeat MRI showed rapid enlargement to an 11.6 x 7.7 cm mass with additional left atrial involvement and vascularity. Biopsy confirmed high-grade primary cardiac angiosarcoma.<br /><br />The report emphasizes that primary cardiac angiosarcoma is a rare but highly aggressive malignancy that often presents with nonspecific symptoms such as dyspnea or signs of impaired cardiac function. Recurrent pericarditis should raise suspicion when symptoms persist despite appropriate treatment. Pericardial fluid cytology is often falsely negative, even when invasive disease is present. Imaging is critical: transthoracic and transesophageal echocardiography are sensitive for cardiac masses, and cardiac MRI may be even more sensitive.<br /><br />Although early diagnosis and surgical resection offer the best chance for survival, prognosis remains poor, with median survival around 20 months. In this case, surgery was not performed because of high operative risk, and chemotherapy with gemcitabine and docetaxel was started. The patient died 5.5 months later.<br /><br />Overall, the case highlights the importance of repeated cardiac imaging in patients with recurrent pericarditis, especially when the clinical course is atypical or refractory to standard management.

Asset Subtitle

Ethan Molitch-Hou

Meta Tag

Author List David R. Beam, Ethan Molitch-Hou, Zhong Huang

Category Clinical Vignettes

Concept Primary Cardiac Angiosarcoma

Concept Malignancy

Concept Recurrent Pericarditis

Concept Pericardial Effusion

Concept Cardiac Tumor

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Ethan Molitch-Hou

Track Adult

Keywords

primary cardiac angiosarcoma

recurrent pericarditis

pericardial tamponade

cardiac mass

cardiac MRI

echocardiography

pericardial fluid cytology

right atrium

biopsy confirmation

gemcitabine and docetaxel

Primary Cardiac Angiosarcoma

Malignancy

Recurrent Pericarditis

Pericardial Effusion

Cardiac Tumor