To investigate the clinical and echocardiographic manifestations of primary cardiac angiosarcoma (CA) in order to provide a basis for its clinical diagnosis and treatment.

The clinical data and echocardiographic features, including the tumor location and adjacent infiltration, of 12 cases of CA pathologically diagnosed at Anzhen Hospital from 2009 to 2021 were reviewed retrospectively.

Twelve patients with CA were identified, including eight males and four females, with an average age of (44±15) years old. Of the 12 individuals included, six had distant metastases and six had localized CA. Ten of them were described by echocardiography as having cardiac space-occupying lesions, all located in the right heart cavity with a wide base; the remaining two cases were diagnosed with pericardial angiosarcoma, which showed an isolated massive pericardial effusion on echocardiography and no clear space-occupying lesion was found. Pericardial involvement was a common complication; six cases (6/12, 50%) presented with pericardial effusion, and one patient had a negative pericardial effusion cytology. Both the left and right ventricles were functioning normally in all the 12 cases. Some patients had abnormal hemodynamics, three cases (3/12, 25%) had tricuspid orifice obstruction, two (2/12, 17%) had superior vena cava orifice obstruction, and another two had poor motion of posterior leaflet of tricuspid valve due to tumor compression. One case had right ventricular basal dyskinesia.

Echocardiography is sensitive in detecting intra-cardiac masses. CA tends to occur in the right side of the heart chambers and is prone to invade adjacent structures, with pericardial effusion being the most common. The echocardiographic features of CA remain to be further explored and determined.