Cardiac Angiosarcoma: From Cardiac Tamponade to Ischaemic Stroke – A Diagnostic Challenge

Cardiac angiosarcoma (CA) is the most common primary malignant heart tumour. Its atypical symptoms and rapidly progressive nature contribute to delayed diagnosis and poor outcome. We report the case of a 52-year-old woman admitted with a large pericardial effusion. An extensive study of the aetiology of the pericardial effusion was inconclusive. Two months later the patient returned with ischaemic stroke. An echocardiogram revealed a probable right atrium contained rupture. The patient was submitted to surgical correction but died 9 days later. Histology revealed an angiosarcoma. This case exemplifies the atypical presentation of CA and highlights the importance of a multimodal diagnostic work-up in patients with idiopathic pericardial effusion. LEARNING POINTS: Cardiac angiosarcoma is often overlooked as an initial diagnosis because of its rarity and atypical symptoms, which, in association with its aggressiveness, contribute to delayed diagnosis and fatal outcome. Pericardial biopsy is an important technique that may help to disclose the aetiology of pericardial effusion and should be considered for the confirmation of malignant pericardial disease. Patients presenting with pericardial effusion with cardiac tamponade with an unclear cause after diagnostic work-up should be followed closely.