Case report: angiosarcoma of the pulmonary artery diagnosed as pulmonary artery emboli

• Published in: Journal of cardiothoracic surgery 2022-11, Vol.17 (1), p.1-288, Article 288
• Main Authors: Korça, Edina, Kanaan, Jad, Benke, Kálmán, Veres, Gábor, Michaelsen, Jens, Szabó, Gábor
• Format: Article
• Language: English
• Subjects: Angiosarcoma; Arrhythmia; Autopsies; Blood clots; Blood vessels; Cancer; Cardiac tumor; Cardiology; Care and treatment; Case Report; Case reports; Catecholamines; Chemotherapy; Compression; Computed tomography; Diagnosis; Differential diagnosis; Dyspnea; Effusion; Ejection fraction; Emboli; Heart; Heart attacks; Intensive care; Lysis; Magnetic resonance imaging; Metastases; Metastasis; Patients; Pulmonary arteries; Pulmonary artery; Pulmonary embolisms; Surgery; Sutures; Tomography; Transplants & implants; Tumor markers; Tumors; Veins & arteries; Ventricle; Ventricular fibrillation
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-022-02036-w

Background Angiosarcomas are the most common malignant tumors of the heart and great vessels. Late onset and unspecific symptoms are reasons why a diagnosis is made rather late at a time when most tumors have already metastasized. We report a rare case of an angiosarcoma presenting as pulmonary artery emboli. Case presentation A 66-year-old patient was initially admitted to the hospital with a STEMI. Days later a successful reanimation due to ventricular fibrillation followed. An emboli of the pulmonary artery was diagnosed as the cause and after a lysis therapy the patient was discharged. A few weeks later the patient suffered an episode of absolute arrhythmia. TTE as well as CT-Scan showed an emboli of the pulmonary artery and a pericardial effusion with compression to the right ventricle. Intraoperative findings, showed an infiltrating tumor of the pulmonary artery, the pulmonary valve, the RVOT, the LA and LV. A resection of the tumor from the pulmonary artery, valve and RVOT was carried out. A new pulmonary valve was implanted with the reconstruction of the RVOT and pulmonary artery. Due to LV infiltration, only a palliative surgical approach was possible. Despite an uncomplicated postoperative course, the patient died at home two months later. Conclusion Although a rarity, a tumor of the pulmonary artery should be taken into consideration as a differential diagnosis to pulmonary artery emboli. Development of better diagnostic tools (specific tumor markers) and more effective chemotherapeutic agents is necessary to improve the prognosis of these patients. Keywords: Angiosarcoma, Emboli, Pulmonary artery, Cardiac tumor