Primary angiosarcoma of the ascending aorta presenting with acute coronary syndrome

Primary cardiac and aortic angiosarcomas are rare and clinically challenging malignant tumors of vascular origin, with >90% arising from the right atrium. Clinical manifestations appear from myocardial ischemia, mass effect, or distant metastases. If origination from the ascending aorta (AAo), angiosarcoma tumors can elude detection by trans-thoracic echocardiogram. We present a case of a 55-year-old male with acute coronary syndrome (ACS) and cardiogenic shock, who was found to have primary aortic angiosarcoma of the AAo with multifocal hemorrhagic brain metastases. Aortic angiosarcoma is an extremely rare and aggressive tumor with poor prognosis, and can be difficult to diagnose. Despite complete surgical resection, cardiac and aortic angiosarcomas carry a high mortality rate, often with recurrence and metastases to lungs, bones, and brain. This report highlights an unusual presentation of a rare disease, and the importance of multimodal diagnostic strategies in complex presentations of ACS