PMC6546259_01
(a) Transthoracic echocardiogram, subcoastal view with a large pericardial effusion. (b) Transthoracic echocardiogram, parasternal long-axis view demonstrating a large pericardial effusion.
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figure1
An emergent transthoracic echocardiography (TTE) showed a large pericardial effusion with early tamponade (Figure 1).
(a) Cardiac MRI of the patient with cine RV-2 chamber view showing the pericardial mass encasing the right atrioventricular groove (AV) groove (solid red arrow). Labelled RA: Right atrium; RV: Right ventricle; IVC: Inferior vena cava. (b) Tissue characteristics of the right atrial mass.
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figure2
Due to the patient's tamponade and worsening cardiac function without an identifiable cause, a cardiac MRI (CMRI) was done to better assess the patient's cardiac structure and function (Figure 2). Her CMRI demonstrated a large, ill-defined right atrial mass isointense on T1 and hyperintense on T2 (Figures 2 and 3). Repeat staging 4 months later showed absent Fluorodeoxyglucose (FDG) uptake in the right atrium and decreased tumour burden (1.3 cm x 1.0 cm) (Figure 2) along with a decreased size of the hepatic lesions.
(a) Cardiac MRI of the patient post two cycles of chemotherapy with cine RV-2 chamber view showing the reduced pericardial mass encasing the right AV groove. (b) Tissue characteristics of the right atrial mass.
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figure3
Her CMRI demonstrated a large, ill-defined right atrial mass isointense on T1 and hyperintense on T2 (Figures 2 and 3).
(a) H&E stain of right atrium cardiac biopsy of the patient showing high-grade spindle cell proliferation and hyperchromatic and pleomorphic nuclei with mitotic activity. (b) Immunohistochemistry of vascular differentiation markers, strongly positive for CD31. (c) Immunohistochemistry of vascular differentiation markers, strongly positive ETS (Erythroblast transformation specific) related gene.
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figure4
The patient had an open biopsy of the cardiac mass via a right anterior thoracotomy approach that indicated a high-grade PCAS (Figure 4).