A 74-year-old woman was admitted with pericardial effusion causing haemodynamic instability. On echographic and radiological examination, a mass was identified in the right atrium, extending into the epicardial layer. In the differential diagnosis of a cardiac mass, benign primary lesions like a myxoma must be distinguished from rare primary cardiac malignancies like sarcomas or more frequent secondary tumours. These include localisations of lymphomyeloproliferative disease and metastases of a melanoma or various subtypes of carcinoma. In this case, histopathological examination of a surgical biopsy showed findings consistent with a high-grade angiosarcoma. Because of the size and localisation, as well as the presence of a possible metastasis in the rib, surgical treatment was not possible. After diagnosis, the patient developed multiple additional metastasis. She received palliative radiotherapy to control the pain and died 10 months after the initial diagnosis was made. Median reported survival is 6 months.
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