ArticleEuropean heart journal. Case reports2025
Heart team rescues a bleeding heart: a case report of cardiac angiosarcoma causing life-threatening tamponade.
Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: There are many causes of pericardial effusion and if the accumulating fluid results in cardiac tamponade, it may lead to life-threatening haemodynamic collapse. Therefore, rapid diagnosis and treatment of cardiac tamponade is critical. Case summary: A 53-year-old woman presented to the emergency department with chest pain and undifferentiated shock. A computer tomography (CT) aortogram showed a pericardial effusion, active contrast extravasation (possibly arising from the right coronary artery), but no aortic dissection. Echocardiography confirmed a large pericardial effusion with tamponade physiology. The consensus between cardiology and cardiothoracic surgery was for urgent coronary angiography to identify the source of bleeding. This showed a network of vessels from the right coronary artery that appeared to supply a mass. Re-review of the CT scan and repeat targeted echocardiography showed the silhouette of a mass adjacent to the right atrium. The patient was taken immediately for cardiac surgery. A cardiac tumour extending through the right atrial wall was identified, resected, and subsequently was diagnosed histologically as a cardiac angiosarcoma. Discussion: Malignancy is responsible for only a small proportion of pericardial effusions and metastatic disease is overwhelmingly more common than primary cardiac neoplasms. This case highlights the use of multi-modality cardiac imaging to guide diagnosis and treatment, and the need to consider the rarer causes of haemopericardium in cases where the more common causes have been excluded.
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