Bilateral lung lesions: when the eyes deceive the brain!

Abstract

We report a clinic case of patient in whom angiosarcoma of the heart presents as bilateral pulmonary nodular infiltrates.

The cardiac tumor was clinically silent, the electrocardiogram was normal and the cough was the only symptom. Chest CT scan (Fig. 1) showed bilateral diffuse nodular infiltrates ranging. Clinical clues, the results of laboratory tests and all of the cultures obtained excluded an infectious etiologies; the findings of CT-guided needle biopsy was inconclusive for a definitive diagnosis. Thus, the patient was scheduled for a thoracoscopic biopsy. Surprisingly, the pre-operatory echocardiogram showed a soft tissue mass fixed to the posterior wall of the right atrium. On retrospective reviewing of chest CT scan, a tumor was evident in the right atrium, but it was missed initially. In theory, the lung lesions attract the attention of the observer who had not taken into account anything else as to say: “the brain knows what the eyes want”.

The diagnosis of pulmonary metastases was obtained by means of pleural biopsy during right thoracoscopy. Immunoistochemical staining revealed a CK(-), CK7(-), EMA(-), ESA(-), CEA(-), TTF1(-), Vimentina(+), CD31(+), CD117(+) lesion. Because at the time of diagnosis our patient already had lung metastases, he underwent chemotherapy