SITUS INVERSUS TOTALIS COMPLICATED WITH BRONCHIAL AND LARYNGEAL CARCINOMA - A CASE REPORT

and auscultation revealed diffuse crepitation in both lung fields. Moreover he had an elevated jugular venous pressure and an impalpable cardiac apex with muffled heart sound. Abdominal examination was unremarkable. Results and Conclusion: Complete blood count, inflammatory markers and renal functions were insignificant. His ECG demonstrated sinus tachycardia and Chest X-ray portrayed a globular heart with diffuse alveolar shadows. Furthermore Echocardiography depicted moderate pericardial effusion without tamponade effect whereas pericardial fluid analysis revealed haemorrhagic exudative effusion with negative cytology. On the other hand culture and gene Xpert reports, Mantoux test and sputum AFB were negative. Histology of pericardial biopsy revealed patchy mild chronic inflammation of pericardial tissue without granulomata or malignancy. As he was clinically deteriorating he was treated with pericardiotomy to relieve the pericardial effusion and further investigated with CECT chest which depicted lymphangitis carcinomatosis. His condition, however, further deteriorated and extensive management intervention could not defeat his death. Conclusively his autopsy revealed an angiosarcoma of the heart with multiple pulmonary metastases. Undeniably most angiosarcomas are aggressive, rapidly progressive tumours which entail a biopsy to confirm its diagnosis. Regrettably numerous patients with angiosarcoma are diagnosed after extensive metastasis and this late diagnosis results in its poor prognosis.