Clinical Picture

An unexpected finding in an asymptomatic patient with

atrial fibrillation: cardiac angiosarcoma
Alfonso Campanile*, Guido Tavazzi*, Mohammed Harith Alam, Richard Paul, Susanna Price

A 70-year-old asymptomatic man was found to have atrial third. 30–45% of malignant sarcomas are angiosarcomas, Published Online
fibrillation during a routine check-up by his family which usually arise in the right atrium near the April 7, 2016
http://dx.doi.org/10.1016/
doctor. He was referred to hospital for further atrioventricular groove (unlike myxomas, they rarely arise S0140-6736(16)00086-6
investigation, where transthoracic echocardiography from the interatrial septum). Patients usually present *Joint first authors
showed a large echogenic intra-atrial mass that almost with symptoms related to the tumour size, such as right-
Department of Cardiology,
obliterated the left atrium (figure, videos). Trans- sided heart failure, compression syndrome, chest pain, or dell’Angelo Hospital,
oesophageal echocardiography showed a space- haemopericardium. Intracardiac angiosarcomas have an Mestre-Venice, Italy
occupying lesion 9·5 × 7·2 cm arising from the interatrial especially poor prognosis because they tend to present (A Campanile MD); University
of Pavia Department of
septum, filling the left atrium, bulging into the right with metastatic disease, most frequently pulmonary and
Anaesthesia, Intensive Care
atrium and close to the mitral-aortic continuity. Cardiac hepatic metastases. Incidental finding of angiosarcoma is and Pain Therapy
MRI showed that the mass was encapsulated, with mixed rare. Evaluation of intracardiac tumours can be complex (G Tavazzi MD), and
fibrous and cystic components (video). Coronary and should include a variety of diagnostic techniques. Department of Anaesthesia
and Intensive Care, Emergency
angiography was normal, and fluorine-33-labelled Diagnosis relies on non-invasive imaging techniques and Department (G Tavazzi),
fluorodeoxyglucose (³³FDG) PET-CT showed no FDG tissue histology. Echocardiography is best for assessment Fondazione Policlinico
accumulation. Histology of the mass after complete of the tumour’s effect on flow dynamics, and cardiac MRI San Matteo IRCCS, Pavia, Italy;
surgical excision confirmed an angiosarcoma. 1 year later is useful for detection of tumour infiltration and tissue Adult Intensive Care Unit,
Royal Brompton Hospital,
he remained in atrial fibrillation but had no cardiac or characterisation. Royal Brompton & Harefield
systemic tumour recurrence and was otherwise well. Contributors NHS Foundation Trust,
Primary cardiac tumours are rare (0·0017–0·02% of all All authors cared for the patient and contributed to writing of the report. London, UK (M H Alam MD,
cardiac tumours), of which sarcomas account for about a Written consent to publication was obtained. R Paul MD, S Price PhD); Imperial
College London, London, UK
V V (M H Alam); and National
A B Institute for Health Research,
London, UK (R Paul)
LV
RV Correspondence to:
Dr Guido Tavazzi, Department of
Tumour
Anaesthesia, Intensive Care and
Pain Therapy, Fondazione
Policlinico San Matteo IRCCS,
Pavia, Italy
gtavazzi@yahoo.it

Tumour See Online for videos

C D
RA RV

LV

Tumour

Figure: Cardiac angiosarcoma found as part of a routine check-up

(A) Transthoracic echocardiography (TTE) (parasternal long axis view) showing the mass almost obliterating the left atrium. (B) TTE (apical four chambers view) shows the
mass bulging and squeezing the right atrium. (C) T2 weighted turbo spin echocardiography (t2-TSE) sequence (four chamber view) showing patchy low-intermediate
signal intensity suggestive of heterogeneous tissue within the mass. LV=left ventricle. RV=right ventricle. RA=right atrium. (D) Balanced steady state free precession
(b-SSFP) cine still, four chamber view, showing the interatrial septal mass impinging on both atria.

www.thelancet.com Published online April 7, 2016 http://dx.doi.org/10.1016/S0140-6736(16)00086-6 1