Early Diagnosis of Primary Right Atrial Angiosarcoma From Intraoperative Transesophageal Echocardiographic Findings of Right Atrial Pseudoaneurysm and Cardiac Rupture.

Primary cardiac angiosarcoma is a rare and aggressive malignant tumor with a poor clinical outcome. Its nonspecific symptoms often complicate early diagnosis. Here, we present the case of a 39-year-old man who initially presented with pericardial effusion and cardiac tamponade. Despite multiple transthoracic echocardiography (TTE) and computed tomography (CT) scans from admission to surgery, no cardiac tumor was detected. After admission, pericardial drainage was performed following the parasternal approach. On day 5 after admission, TTE and chest CT revealed increased pericardial effusion compared to post-drainage on admission. On day 6 of admission, the patient underwent a left pericardial window creation under general anesthesia. We did not suspect malignancy until an intraoperative transesophageal echocardiography (TEE) was performed, which revealed a right atrial pseudoaneurysm despite subsequent negative imaging results. On day 7 of admission, the patient was treated with surgical resection of the pseudoaneurysm and repair of the right atrial wall, followed by a histopathologic diagnosis of cardiac angiosarcoma. The patient recovered without major complications, was discharged from the hospital, and is doing well. Early surgical intervention, as evidenced in this case, can substantially improve patient outcome. This report provides valuable insights into the management of cardiovascular angiosarcoma. We emphasize the importance of a multifaceted, comprehensive diagnostic evaluation that includes the use of advanced imaging modalities, such as TEE, to make a timely and accurate diagnosis, even in the absence of obvious tumor findings.