Massive pericardial effusion as a manifestation of cardiac angiosarcoma

Objective: Pericardial effusion, resulting from various conditions including infections, malignancies, and postoperative complications, can lead to significant diagnostic challenges, especially in cases where hemopericardium is present.The purpose of presenting this clinical case is to increase awareness and alertness among medical professionals to exclude neoplastic involvement of the heart when hydro-or hemopericardium is detected.Case presentation: A 39-year-old female patient was admitted with a diagnosis of chronic exudative pericarditis for subtotal pericardiectomy, presenting with shortness of breath, dizziness, general weakness, and chest pain.Her medical history included two prior pericardial punctures yielding 1200 ml of hemorrhagic exudate each.Preoperative imaging revealed a massive hemopericardium and a multi-nodular pericardial mass originating from the right atrium, with involvement of the right coronary artery and adjacent structures.Based on the imaging findings, a preliminary diagnosis of cardiac angiosarcoma was made.Surgical cytoreduction on a beating heart with cardiopulmonary bypass was performed, followed by successful tumor debulking.Postoperative recovery was marked by significant clinical improvement.Histological and immunohistochemical analysis confirmed lowgrade angiosarcoma.The patient was referred for adjuvant chemotherapy.This case underscores the complexity of managing cardiac angiosarcoma with pericardial involvement and highlights the role of multimodal treatment in such rare malignancies.Conclusion: This case highlights the urgent need for early detection of neoplastic involvement in patients presenting with pericardial effusion.While hydropericardium is often associated with conditions such as pericarditis, heart failure, and infections, it can also indicate underlying malignancies like primary cardiac angiosarcoma, which may present as massive hemopericardium.Comprehensive imaging, particularly CT scans with intravenous contrast, is crucial for identifying potential tumors and assessing their extent, thereby guiding surgical planning.Timely diagnosis is essential not only for effective management but also for improving patient outcomes in cases of cardiac tumors.