PMC10250602_01
A chest X-ray showed an enlarged heart shadow and possible left pleural enveloping effusion (A). CT indicated curved fluid density shadows in the bilateral thorax and pericardial cavity and irregular, slightly low-density shadows in the right atrium (B, C).
fonc-13-1164153-g001.jpg
PMC10250602_01_fonc-13-1164153-g001.jpg
f1
Upon examination, a chest X-ray showed an enlarged heart shadow and possible left pleural enveloping effusion ( Figure 1A ). According to the computed tomography (CT) report, an irregular, slightly low-density shadow in the right atrium displayed middle-volume bilateral pleural and pericardial effusion ( Figures 1B, C ).
TTE showed an isoechoic mass of approximately 41 * 32 mm in the right atrium, with a broad base, multiple echo-free zones, and thickened surrounding chamber walls (A-C). A dark area of fluid was visible in the pericardial cavity, and the fluid area was clear (D). TTE, transthoracic echocardiography.
fonc-13-1164153-g002.jpg
PMC10250602_01_fonc-13-1164153-g002.jpg
f2
Transthoracic echocardiography (TTE) showed a mass in the right atrium (approximately 41 * 32 mm) and fluid effusion in the pericardium (moderate volume) ( Figures 2A-D ).
Re-examination of the TTE showed an isoechoic mass of approximately 39 * 37 mm at the top of the right atrium with a wide base and multiple echo-free zones. The surrounding atrial wall was thickened, and the width of the inferior vena cava was approximately 23 mm (A). A dark area of fluid was visible in the pericardial cavity, and the fluid area was not clear (B). TTE, transthoracic echocardiography.
fonc-13-1164153-g003.jpg
PMC10250602_01_fonc-13-1164153-g003.jpg
f3
TTE re-examination showed an isoechoic, wide-based mass of approximately 39 * 37 mm at the top of the right atrium, which was considered the right atrial mass ( Figure 3A ). In addition, moderate-massive effusion was evident in the pericardium ( Figure 3B ).
A contrast-enhanced CT of the chest showed arc-shaped fluid density shadows in the bilateral thorax and pericardial cavity, while irregular, slightly low-density shadows with unclear boundaries were evident in the right atrium (red arrow). Most of the lesions were not enhanced, and the edges appear locally enhanced (A-D).
fonc-13-1164153-g004.jpg
PMC10250602_01_fonc-13-1164153-g004.jpg
f4
CT of the chest and abdomen indicated an irregular, slightly low-density shadow with unclear boundaries in the right atrium ( Figures 4A-D ). Considering the patient's critical condition and poor physique, surgery was eliminated as an immediate option, instead providing symptomatic treatment, such as fluid rehydration, oxidative atomization, and anti-infection.
During the operation, a tumor protrusion of approximately 10 * 15 mm was evident on the surface of the right atrium. The serosal surface of the right atrium and superior vena cava showed cowhide changes (A). Although the mass proliferated between the inner and outer membranes of the right atrial wall, it did not breach the atrial cavity (B). The size of the mass was approximately 50 * 40 mm. The tumor morphology was considered for atrial sarcoma diagnosis (D, E). The tumor was completely removed, as well as part of the atrial wall, and the right atrial defect was sutured with a pericardial patch (C).
fonc-13-1164153-g005.jpg
PMC10250602_01_fonc-13-1164153-g005.jpg
f5
The serosal surface of the right atrium and superior vena cava showed cowhide changes ( Figure 5A ). Next, the right atrium was dissected, revealing a mass between the walls of the right atrium ( Figure 5B ). The tumor was completely removed, as well as a section of the atrial wall ( Figures 5D, E ), and the right atrial defect was sutured with a pericardial patch ( Figure 5C ).
Histopathology confirmed that the tumor was a primary cardiac angiosarcoma (A). Pathological investigation showed vascular hyperplasia, labyrinth and sinusoid structures, obvious cell atypia, mitosis, and massive necrosis in H&E stains (B).
fonc-13-1164153-g006.jpg
PMC10250602_01_fonc-13-1164153-g006.jpg
f6
Considering the vascular proliferation, labyrinthine and sinus-like angiosarcoma, marked cellular atypia, mitosis, and massive necrosis, the histopathological diagnosis was a tumor of vascular origin ( Figures 6A, B ).