angiosarcoma. Due to the non-specificity of symptoms and rarity of the disease it is often missed by doctors and initial diagnosis may be delayed. A 2012 study reported that 56% of patients presented with pericardial effusion with or without cardiac tamponade. The most common finding on imaging is cardiomegaly. Prognosis is generally very poor with a mean survival rate of three months to four years following diagnosis. Metastasis at time of diagnosis is common. Primary liver angiosarcoma Primary angiosarcoma of the liver is the third most common type of liver cancer however it only makes up 0.1–2.0% of all liver cancers. It is rapidly fatal with most individuals dying within six months or a year even with surgical resection. Despite being associated with arsenic, vinyl chloride, thorotrast and other chemicals, 75% of liver angiosarcomas have no known cause. Men are more commonly affected in a ratio of 3–4:1 however in children girls are more often affected. If symptomatic it often presents with non-specific liver related symptoms such as abdominal pain, jaundice, fatigue, unintended weight loss and distension. Deep soft tissue angiosarcoma Angiosarcoma in the deep soft tissue such as adipose tissue, ligaments or muscles. These make up about 10% of angiosarcoma. Signs and symptoms Cutaneous angiosarcoma may initially look like a bruise or a purplish-red papule. It may look like a benign tumor which can delay correct diagnosis and treatment. Fungation, ulceration and bleeding may develop. Cardiac angiosarcoma may present with shortness of breath, chest pain (46%), weight loss, anemia-like symptoms, low blood pressure and syncope. Angiosarcomas principally metastasises through the blood with the most common site for metastasis being the lungs, this may present as pleural effusion, pneumothorax or other pleural disease. Other common sites of metastasis include the liver, bone and lymph nodes. Causes Angiosarcoma develops when damage to the DNA of endothelial cells causes them to divide uncontrollably and prevents programmed death. This allows them to grow into a mass invading other parts of the body and consuming its resources. If part of the mass breaks off and enters the circulatory or lymphatic system (which is very common due to angiosarcomas arising from the lining of said systems) it allows them to lodge elsewhere in the body. This process is called metastasis and is a negative prognostic factor. The underlying causes of DNA damage is not understood but several risk factors are widely accepted. Accepted risk factors