Background: Primary cardiac angiosarcoma is a rare malignancy with high predilection
to involve surrounding structures such as pulmonary metastases. We analysed the chest computed
tomography (CT) imaging features of patients diagnosed with primary cardiac angiosarcoma with
pulmonary metastases in this study.
Methods: This study retrospectively reviewed 12 patients with confirmed primary cardiac angiosarcoma,
out of which eight (all men) with pulmonary metastasis were included in the analysis. The
patients’ age ranged from 17 to 74 (mean: 48) years. CT was performed in all patients with unenhanced,
contrast-enhanced, and both scans were done in 1, 3 and 4 patients, respectively.
Results: Nodular lesions were observed in 7 patients with multiple solid nodules observed in 6 out
of 7 patients. A solitary solid nodule was found in the remaining patient in the upper lobe and apical
segment of the right lung with a diameter of 11.7 mm. All solid nodules were distributed along
with bronchovascular bundles in the lungs, and their maximum diameter ranged from 2.3 to 19.9
mm. Nodules larger than 10 mm in diameter were heterogeneously enhanced on contrast-enhanced
CT images (5/8 patients), whereas those smaller than 10 mm were homogeneously enhanced (3/8
patients). Other imaging features, namely the tree-in-bud pattern, emphysema, pleural effusion, and
mediastinal lymph node enlargement, were observed in 4, 3, 3, and 2 patients, respectively.
Conclusion: CT enhancement features of pulmonary metastasis in patients with primary cardiac angiosarcoma
depend on the size of pulmonary nodules, with larger ones being heterogeneous and
smaller ones homogeneous. Other signs are less noticed.