Metastatic intrapulmonary hemorrhagic foci secondary to cardiac angiosarcoma: a case report

BACKGROUND: Cardiac angiosarcoma is a very rare malignant neoplasm, typically showing terrible prognosis. Therefore, early diagnosis is essential for efficacious intervention. Here we report a cardiac angiosarcoma with unique imaging findings because of pulmonary metastases. CASE PRESENTATION: A 55-year-old man presented to our Respiratory Department because of mild morning hemoptysis for five weeks with occasional palpitations, having undergone futile antibiotic therapy for two weeks at his local hospital before admission. Symptoms of hemoptysis were alleviated with venous hemostatic drugs. (18)F-FDG PET/CT was performed, showing a right atrial mass with multiple parenchymal nodules in lungs surrounded by ground-glass opacity, and indicated an intracardiac malignant tumor associated with pulmonary metastases, consistent with cardiothoracic CT and ultrasound. No evidence of infection or neoplasm was found using a fiberoptic bronchoscope. After multidisciplinary consultation and discussion, provisional diagnosis was established such that metastatic intrapulmonary hemorrhagic foci were secondary to intracardiac malignancy. A percutaneous biopsy from the left lung was carried out and but showed mild chronic inflammation of the lung. Therefore, urgent wedge resections for biopsy were performed from the right lung and the histopathology revealed angiosarcoma. The patient died of cardiorespiratory failure before anticancer therapy. CONCLUSIONS: Variety of clinical manifestations of cardiac angiosarcoma frequently makes its diagnosis difficult, the imaging features and epidemiology of cardiac malignancy are very significant to clinical diagnosis.