Angiosarcoma: the evil behind atrial tachycardia

摘要

A 51-year-old man with recurrent palpitation and an episode of syncopewithin 1 month was referred to our centre. The patient wasfound to have supraventricular tachycardia at a local hospital whenroutine echocardiography before scheduled radiofrequency ablationincidentally detected an intracardiac mass of unknown origin. On admission,physical examination of heart and lungs was unremarkablewhereas two palpable, well defined, non-tender subcutaneous nodules,measuring 1.8 cm 1cm, were noted on the chest wall. The patientwas not confident about an earlier existence of these nodules.Echocardiography at our centre revealed a non-homogeneous mass anchoringto the upper wall of right atrium (RA) (Supplementary material online,Figure S1, arrow) with an extension causing narrowing superiorvena cava orifice (Figure 1, arrows). Subsequent cardiac computedtomography (CT) confirmed the presence of right atrial mass (Figure2, arrow). Further abdominal CT detected multiple subcutaneous(Supplementary material online, Figure S2, arrow) and bilateral adrenalnodules (Supplementary material online, Figure S3, arrows) whichwere suggestive of tumour metastasis. Electrocardiogram disclosedatrial tachycardia (Supplementary material online, Figure S4) duringhis self-reported palpitation which exacerbated in upright position.Finally, biopsy of the subcutaneous nodules indicated malignantangiosarcoma. Approximately 90% of primary cardiac angiosarcomasarise in the RA. Invasive as they are, most of the tumours progress insidiouslywithout specific clinical features. Atrial tachycardia as in our . patient is a rare chief complaint, especially in the absence of generalsymptoms and signs of malignancy, which would complicate the diagnosis.Awareness should be raised when a non-pedunculated, nonhomogeneousright atrial mass is inspected by initial echocardiography,and advanced imaging techniques enable further differentiationfrom other diseases. Pathological examination of intracardiac massremains the diagnostic standard, however, biopsy of easily attainablemetastatic foci may be a reasonable alternative.