Pericardial Angiosarcoma: An Elusive Diagnosis

We report a 33 year-old man who presented to an outside hospital with chest pain and dyspnea on exertion. An echocardiogram demonstrated a large pericardial effusion. The patient underwent pericardiocentesis, which removed two liters of hemorrhagic fluid; however, the effusion recurred, requiring open drainage via a subxiphoid incision during the same admission. Postoperatively the effusion recurred, and the patient was transferred to our institution. An echocardiogram demonstrated tamponade physiology and for this reason, the patient was taken to the operating room for drainage of the recurrent effusion. An incision was made over the patient’s previous subxiphoid incision but due to extensive adhesions the operation was converted to a median sternotomy. These adhesions resembled an acute inflammatory process. Multiple pockets of hemorrhagic effusion were drained. Pericardial and epicardial biopsies demonstrated dense fibroconnective tissue consistent with fibrinous pericarditis. Cytology revealed abundant red blood cells. The patient’s immediate post-operative course was uncomplicated, and he was discharged on a course of non-steroidal anti-inflammatory drugs and colchicine....