PMC9366849_01
CT from chest to pelvis with enhancement shows right atrial tumor, small ground-glass pulmonary nodule, and bone destructions. (A) Arterial phase imaging reveals a filling defect in the right atrium (arrowhead). (B) Venous phase imaging shows the tumor inhomogeneously enhancing (arrowhead). (C) A lung window image shows a metastatic nodule in the upper right lung. (D) Bone destructions in the right ilium and sacrum.
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F1
A CT examination from the chest to the pelvis was performed, which revealed a right atrial mass, multiple small ground-glass pulmonary nodules, and bone destructions (Figures 1A-D).
Cardiac magnetic resonance imaging. (A) On SSFP cine imaging planned in the four chambers, the tumor shows isointense (arrowhead). (B) On T2-short tau inversion recovery sequence images, the tumor displays high-signal intensity (arrowhead). (C,D) On enhanced MR imaging, the tumor shows arterial heterogeneous enhancement and progressive but incomplete enhancement in the delayed phase (dynamic acquisition).
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F2
On steady-state free precession (SSFP) cine imaging planned in the four chambers, the tumor showed isointense (Figure 2A). On T2-short tau inversion recovery (STIR) sequence images, the tumor displayed high-signal intensity (Figure 2B). On enhanced MRI, the tumor showed arterial heterogeneous enhancement and progressive but incomplete enhancement in the delayed phase (dynamic acquisition) (Figures 2C,D).
PET-CT demonstrates the tumor intensely increased FDG uptake with bony metastases (arrowhead).
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F3
PET-CT images demonstrated that the right atrial tumor had intensely increased FDG uptake (standardized uptake value, SUVmax, 8.4) with signs of pulmonary and bony metastases (Figure 3).
Histology of resection from the left lower lung nodule. The spindle cells are CD34 (A, 200 x) and ERG (ETS-related gene) (B, 200 x) positive.
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F4
CD31, CD34, ETS-related gene (ERG), and Ki67 (LI: 60%) (Figures 4A,B). Combined with multimodality images, the final diagnosis was primary right atrial angiosarcoma with multiple metastases.
Repeat cardiac magnetic resonance imaging and thoracic CT. (A) SSFP cine imaging planned in the four chambers shows the tumor markedly reduced. (B) Thoracic CT shows the pulmonary nodules obviously decreased too, compared with Figure 1C.
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F5
Repeat CMRI and chest CT showed significant regression of the tumor and pulmonary metastases (Figures 5A,B).