Korean Circ J.  2022 Jul;52(7):560-562. 10.4070/kcj.2022.0069.

Multimodality Imaging for Pericardial Epithelioid Angiosarcoma Presenting With Pericardial Effusion and Constrictive Pericarditis

• Kim SE
• Lee SH
• Ko KY
• Shim CY
• Hong GR

• KMID: 2530739
• DOI: http://doi.org/10.4070/kcj.2022.0069

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  Figure 1 Multimodality images with TTE, CT, PET-CT. (A-D) Image 1-year prior, (E-J) Image in this time, and (K and L) Histopathologic findings.(A, B) Large amount of PE with pericardial tamponade was shown on the apical 4-chamber view and the parasternal short-axis view of mid-left ventricular level of TTE; (C) Heart CT showed normal heart structure without pericardial thickening or pericardial masses; (D) PET-CT showed mild hyper-metabolic activity along the pericardium that suggested pericarditis. (E) The subcostal view of TTE showed pericardial thickening with aggravated pericardial adhesion (yellow arrow); (F) Mitral peak E-wave of 1.27 m/s (expiration) and 0.81m/s (inspiration), 36% drop in mitral E-wave velocity; (G, H) Heart CT showed not only diffuse pericardial enhancement and thickening combined with small amount of PE but also newly developed multiple necrotic pericardial masses around left atrium and right atrioventricular groove that suggested malignant tumor, such as angiosarcoma (yellow arrows); (I, J) Hyper-metabolic multiple masses at pericardium suggested pericardial malignancy were shown on PET-CT (yellow arrows); (K, L) Histopathologic finding showed atypical spindle cell infiltration and immune-histochemical staining showed the positive for vimentin, which were consistent with an epithelioid feature of high-grade sarcoma that suggested epithelioid angiosarcoma.CT = computed tomography; PE = pericardial effusion; PET = positron emission tomography; TTE = transthoracic echocardiography.