Figure 1

Preoperative imaging of primary right atrial angiosarcoma. A. The chest X-ray shows enlargement of the right atrial border (the cardiothoracic ratio is 0.56). B. Transthoracic echocardiography (TTE) (two chamber view of the right heart); confirms pericardial effusion, and shows a giant mass (51 × 44 mm) that infiltrates the right atrial free wall and that protrudes into the right atrium (red arrows). C. Contrast angiogram of the right coronary artery (right anterior oblique projection) showing the right coronary artery and two right atrial branches (red arrowheads) with several small areas of abnormal contrast enhancement, characteristic of a "tumor blush" (red arrows) (representing new vessel formation feeding the angiosarcoma). D. FDG (fluorodeoxy-glucose-18) PET-CT scanning (transverse section, four chamber view) to assess metabolic activity reveals hypermetabolic uptake of FDG in the right atrium (red arrow), consistent with malignancy. Paravertebrally, there is physiologic brown fat activity. E. Turboflash 2D cine MRI (sagittal section, through the superior vena cava); large inhomogenous tumor in the lateral wall of the right atrium (diameter of approximately 74 mm), extending into the wall of the superior vena cava (red arrow). F. CT (reconstruction along the cardiac axis); large inhomogenous tumor in the lateral wall of the right atrium, protruding into the right atrium (64 × 53 mm), without invasion of the right ventricular wall (red arrows). A, coronal plane; L, sagittal plane; H, horizontal plane; RA, right atrium; RV, right ventricle; SVC, superior vena cava.