Cardiac angiosarcoma: how multimodality imaging and excimer laser assisted intracardiac biopsy led to the correct diagnosis-a case report.

Background: Cardiac angiosarcomas are exceptionally uncommon, and result in significant morbidity and mortality. Utilizing a multimodality approach enhances the characterization of the mass for optimal diagnostic outcomes. The recommended primary treatment involves complete surgical resection coupled with adjuvant radiochemotherapy. Excimer laser sheaths provide a novel option for extracting substantial tissue samples, facilitating appropriate and targeted treatment. Case summary: A 54-year-old female presented with dyspnoea and chest pain. Cardiac imaging showed a large right atrial mass suspected to be malignant. Echocardiography was utilized for diagnosis, follow-ups, and as part of the biopsy procedure. However, adopting an off-label approach involving an excimer laser sheath as a bioptome led to the successful diagnosis of an angiosarcoma. Commencement of radiochemotherapy resulted in a reduction in tumour size and a rapid improvement in the patient's quality of life. Discussion: The presented case underlines the significance of multimodality imaging and the use of an excimer laser-assisted intracardiac biopsy in achieving an accurate diagnosis. Cardiovascular imaging not only serves as the primary diagnostic tool but also plays a crucial role in risk stratification and in planning therapeutic interventions.