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Abstract
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CLEAR FILTERS
A Rare Entity presenting with Atrial Flutter
Session:
Casos de Imagem
Speaker:
Pedro Garcia Brás
Congress:
CPC 2020
Topic:
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Theme:
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Subtheme:
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Session Type:
Sessão de Casos de Imagem
FP Number:
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Authors:
Pedro Garcia Brás; Sílvia Aguiar Rosa; Luisa Moura Branco; Maria De Lurdes Ferreira; Alexandra Castelo; Vera Ferreira; Joana Branco Ferrão; Francisca Martins; Lidia De Sousa; António Fiarresga; Eugénia Pinto; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Primary cardiac tumors are rare entities and 75% are benign. Angiosarcoma is the most common malignant primary cardiac tumor.</p> <p>We report the case of cardiac angiosarcoma presenting with an atrial arrhythmia.</p> <p><strong>Clinical case:</strong> A 39-year-old female patient with no past medical history presented to the emergency department with palpitations and atypical chest pain.</p> <p>Electrocardiogram on admission showed atrial flutter with a heart rate of 153 beats per minute. Laboratory analysis were performed showing elevated D-dimer levels (2210 ug/L). A thoracic CT scan was performed, which ruled out pulmonary embolism, but showed multiple pulmonary nodules and a right atrial (RA) mass measuring 48 mm that could correspond to a thrombus or neoplasia.</p> <p>The patient was admitted in the Cardiology ICU of our hospital and was started on beta-blocker and amiodarone with conversion to sinus rhythm. Additional exams were performed:</p> <p>- Transthoracic echocardiogram (TTE) revealed an heterogenous 32.6 x 17.7 mm mass in the lateral wall of the RA with an adherent mobile mass near the tricuspid valve with 28 mm diameter (possible adherent thrombus).</p> <p>- Cardiac magnetic resonance imaging confirmed a RA tumor with invasion of the atrial free wall and compression of the superior vena cava.</p> <p>Due to the unclear etiology of the RA mass, ultrasound-guided intracardiac biopsy was performed. Pathological examination revealed spindle cell proliferation, consistent with the diagnosis of angiosarcoma. Immunohistochemical staining was positive for Vimentin, CD34 and CD31, with 70% Ki67 expression.</p> <p>Later on, the patient developed melena with significant drop of haemoglobin levels, requiring daily red blood cell transfusions and anticoagulation had to be stopped.</p> <p>The patient was transferred to the Internal Medicine ward and thoracic-abdomin-pelvis staging computed tomography (CT) scan showed a significant increase in the number of pulmonary nodules, bilateral ovarian masses, 4 hepatic nodules and ileum metastization.</p> <p>During hospitalization, the patient developed right leg deep venous thrombosis and thoracic CT scan revealed bilateral pulmonary embolism.</p> <p>After improvement of the clinical status, palliative chemotherapy was started and the patient was discharged, maintaining regular outpatient follow-up in the Oncology Department for 1 month.</p> <p><strong>Conclusion:</strong> Cardiac angiosarcoma generally presents in a late stage of the disease with metastatic involvement. When surgical treatment is not possible, despite aggressive chemotherapy, the prognosis remains poor.</p>
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