CTICasesCardiac Angiosarcoma
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Imaging findings
Initial CT chest shows a large hemopericardium and pericardial tamponade, along with an easily overlooked mass along the right atrium. Subsequent cardiac MRI reveals a large, lobulated mass localized to the right atrium and right atrioventricular groove. First-pass perfusion imaging demonstrates rapid, intense hypervascular enhancement comparable to the adjacent cardiac chambers. PET/CT shows intense FDG avidity of the primary mass and hypervascular liver metastases. Coronary angiography demonstrates classic tumor vascularity (or "tumor blush") arising from the right coronary artery.
Key takeaways
Angiosarcoma is the most common primary malignant cardiac tumor, classically originating in the right atrium and often presenting with hemopericardium or tamponade. On MRI, it typically behaves as a large, infiltrative, highly vascular mass. Because of its hypervascular nature, biopsy is highly risky; prognosis is generally poor due to early hematogenous metastasis, particularly to the lungs and liver.
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