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Zuler M, Offenbacher J, Deri Y, Berzon B. Concomitant intravascular and extravascular obstructive shock: a case report of cardiac angiosarcoma presenting with pericardial tamponade. Clin Exp Emerg Med 2022; 9:150-154. [PMID: 35843617 PMCID: PMC9288883 DOI: 10.15441/ceem.20.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/18/2020] [Indexed: 11/26/2022] Open
Abstract
Atraumatic pericardial tamponade and intracardiac masses are both recognized etiologies of acute obstructive shock. Pericardial tamponade, is a cardiovascular emergency commonly considered by emergency physicians and, as a result, evaluation for this process has been incorporated into standardized point of care ultrasound algorithms for assessing hypotension. Obstructive shock secondary to intracardiac tumors is an atypical clinical presentation, and although it is evaluated by the same ultrasound imaging modality, it is generally not considered or evaluated for in the emergency department setting. The concomitant presentation of these two pathologic processes is an extremely rare oncologic emergency. Existing literature on the subject is found in a small number of case reports with nearly no prior descriptions in emergency medicine references. In the right clinical context this unique presentation should be considered and evaluated for in the emergency department via point of care ultrasound modality to help guide in the management of the resulting obstructive shock.
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Affiliation(s)
- Fang-Fang Li
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Yi-Jiang Zhou
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Hui Yan
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310003, China
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Waness A, Batoon AA, Mirza I, Al Mahmeed W. Elusive Cardiac Angiosarcoma in a Young Pregnant Female: Rare Presentation With Fatal Outcome. Cardiol Res 2015; 6:292-296. [PMID: 28197244 PMCID: PMC5295525 DOI: 10.14740/cr402w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 12/15/2022] Open
Abstract
Heart tumors are rare occurrences. They can present diagnostic challenges and severe complications especially in pregnant women. We report a rare case of angiosarcoma (AS) cordis of the right atrium in a young healthy pregnant female. Her diagnosis remained elusive for some time until development of advanced disease symptomatology. The diagnosis was unfortunately clinched when her tumor grew to be detected by imaging modalities. An emergency cesarean section was performed delivering a healthy baby. The patient was aggressively treated with chemotherapy to no avail. She passed away 2 months after her diagnosis was established. Only few cases of the occurrence of aggressive cardiac AS and human pregnancy are documented. The course of this disastrous combination is usually marked by severe complications, difficult therapeutic options and ultimately fast demise. Physicians need to be more aware of such diagnosis and diligently try to diagnose it as early as possible.
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Affiliation(s)
- Abdelkarim Waness
- Obstetrics and Gynecology Department, Sidra Medical and Research Center, Doha, Qatar
| | - Amal A Batoon
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Imran Mirza
- Department of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Wael Al Mahmeed
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Bhattacharyya S, Khattar RS, Gujral DM, Senior R. Cardiac tumors: the role of cardiovascular imaging. Expert Rev Cardiovasc Ther 2013; 12:37-43. [PMID: 24345096 DOI: 10.1586/14779072.2014.872031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of cardiac tumors with cardiovascular imaging aims to establish aetiology, identify complications of tumor and help define management strategy. 2D echocardiography remains the primary diagnostic modality. Additional use of newer echocardiographic techniques such as 3D, strain and contrast echocardiography better characterise tumor morphology, tissue characteristics and vascularity respectively. Cardiac MRI and computed tomography provide complementary information and are able to identify extra-cardiac infiltration and also provide further tissue characterisation. This review explores the non-invasive diagnostic approach to evaluation of cardiac tumors.
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Ruptured cardiac angiosarcoma with pulmonary metastases: a rare disease with a common (mis)diagnosis! Indian Heart J 2012; 64:603-6. [PMID: 23253417 DOI: 10.1016/j.ihj.2012.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/20/2012] [Accepted: 07/17/2012] [Indexed: 11/23/2022] Open
Abstract
In Indian settings pulmonary tuberculosis remains the most common diagnosis in a patient presenting with constitutional symptoms, hemoptysis and lung opacities. We describe a case report of a fifty-year-old woman who was receiving empirical anti-tubercular drugs for a metastatic illness to lungs arising from a primary angiosarcoma in the right atrium. This rare entity was misdiagnosed and typical echocardiographic findings suggested this diagnosis.
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Cardoso ME, Canale LS, Ramos RG, Salvador Junior EDS, Lachtermacher S. Cardiac angiosarcoma. Case Rep Cardiol 2011; 2011:340681. [PMID: 24826214 PMCID: PMC4008244 DOI: 10.1155/2011/340681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 09/20/2011] [Indexed: 11/17/2022] Open
Abstract
Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.
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Affiliation(s)
- Monique Esteves Cardoso
- Unidad de Vigilancia Intensiva de Cardiología Clínica, Instituto Nacional de Cardiología de Laranjeiras, 22.240-006 Rio de Janeiro, RJ, Brazil
| | - Leonardo Secchin Canale
- Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología de Laranjeiras, 22.240-006 Rio de Janeiro, RJ, Brazil
| | - Rosana Grandelle Ramos
- Departamento de Patología, Instituto Nacional de Cardiología de Laranjeiras, 22.240-006 Rio de Janeiro, RJ, Brazil
| | | | - Stephan Lachtermacher
- Unidad de Vigilancia Intensiva de Cardiología Clínica, Instituto Nacional de Cardiología de Laranjeiras, 22.240-006 Rio de Janeiro, RJ, Brazil
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Abstract
Primary tumors of the heart are rare. Among them angiosarcoma is the most common malignant tumor of the heart and is characterized by rapid growth, local invasion, and distant metastasis. Its clinical presentation is variable. We describe a 66-year-old man who suffered from cough and hemoptysis and then experienced rapidly progressing hemorrhagic pericardial effusion. After a set of examinations he was diagnosed as right heart angiosarcoma. His outcome was poor.
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Affiliation(s)
- Yanjun Gong
- Department of Cardiology, Peking University First Hospital, China
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Primary cardiac angiosarcoma: a fatal disease. Case Rep Med 2009; 2009:591512. [PMID: 19724650 PMCID: PMC2731464 DOI: 10.1155/2009/591512] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 07/08/2009] [Indexed: 11/17/2022] Open
Abstract
A 42-year-old man with a cardiac tamponade underwent an urgent pericardiotomy that showed tumoral tissue, covering the surface of the right atrium. The tumor was then partially excised, and the histological examination revealed the presence of a moderately-differentiated angiosarcoma. The patient was then referred to the oncology unit and scheduled for a chemotherapy schedule including Epirubicin (60 mg/m(2), on days 1 and 2) plus Ifosfamide (2000 mg/m(2), on days 1 to 3) and Uromitexan (2000 mg/m(2) at hours 0, 4, 8 after IFO). All drugs were administered every three weeks. After two cycles, a restaging work-up revealed a partial remission. The treatment was continued for another two cycles. A new evaluation by cardiac MRI evidenced a local and distant (lung) progression of disease. The patient died after three months. This paper confirms that cardiac angiosarcoma is a fatal disease, and the prognosis is usually 6-11 months from time of diagnosis.
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Abstract
A rare case of right atrial angiosarcoma is described in a 55-year-old man who was admitted with acute chest pain. Electrocardiography, cardiac enzymes, and chest radiography were negative. His pain settled and he was discharged, but readmitted 15 days later with clinical features of cardiac tamponade. Computed tomography demonstrated a large pericardial effusion. Emergency surgery was performed to excise a right atrial tumor, which histology confirmed to be an angiosarcoma.
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Affiliation(s)
- Kirkpatrick Santo
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Uday Dandekar
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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El-Osta HE, Yammine YS, Chehab BM, Fields AS, Moore DF, Mattar BI. Unexplained Hemopericardium as a Presenting Feature of Primary Cardiac Angiosarcoma: A Case Report and a Review of the Diagnostic Dilemma. J Thorac Oncol 2008; 3:800-2. [DOI: 10.1097/jto.0b013e31817c9282] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim YG, Kim WJ, Park GM, Song JM, Kang DH, Song JK. Echocardiographic Diagnosis of Right Atrial Perforation due to Primary Cardiac Angiosarcoma Using Hand-Agitated Saline Contrast. J Cardiovasc Ultrasound 2008. [DOI: 10.4250/jcu.2008.16.3.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yong-Giun Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Jang Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyung-Min Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Affiliation(s)
- Duane S Pinto
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Abstract
Primary cardiac tumours are rare, with an autopsy incidence ranging from 0.001% to 0.030%. Three-quarters of these tumours are benign and nearly half of the benign tumours are myxomas. Metastases to the heart are far more common than primary cardiac tumours. Primary cardiac tumours present with one or more of the symptoms of the classic triad of: cardiac symptoms and signs resulting from intracardiac obstruction; signs of systemic embolisation; and systemic or constitutional symptoms. They are diagnosed by use of transthoracic and transoesophageal echocardiograms, MRI, and CT scan. Whereas surgery is indicated in patients with benign tumours, systemic chemotherapy is indicated in those who have widespread or unresectable malignant disease, and chemotherapy and radiotherapy are usually combined in treatment of patients with primary cardiac lymphomas. The prognosis after surgery is usually excellent in the case of benign tumours but is unfortunately still limited in localised malignant diseases. Patients with sarcomas live for a mean of 3 months to 1 year, and those with lymphomas live up to 5 years if treated, but usually die within 1 month if untreated.
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