Primary Cardiac Angiosarcoma in a Young Male: Rare Presentation With Right Atrial Endocardial Dissection and Right Coronary Artery Tumor Fistula

ABSTRACT We report the case of a 19‐year‐old man who presented with several months of exertional dyspnea and recent‐onset hemostasis. Initial imaging revealed multiple pulmonary nodules. Days later, he was referred to a specialized center with chest pain and signs of pericarditis. Transthoracic echocardiography (TTE) showed pericardial effusion with hematoma, while transesophageal echocardiography (TEE) revealed a vascularized mass in the right atrial wall supplied by the right coronary artery (RCA), with blood leakage into the pericardial space. Due to concern for cardiac perforation, emergency surgery was decided. Intraoperatively, coronary angiography was performed prior to chest closure due to the anatomical complexity of the RCA. Pathology and immunohistochemistry analysis of cardiac, pericardium, and lung specimens confirmed the diagnosis of primary cardiac angiosarcoma. This case represents the aggressive behavior, diagnostic challenges, and therapeutic complexity of cardiac angiosarcoma, and highlights the importance of early diagnosis, accurate imaging, and a multidisciplinary approach.