Recurrent angiosarcoma with metastases

This 40-years old lady was operated eight months ago for an angiosarcoma of the right atrium. The entire lesion was removed  and the patient underwent further  radiotherapy. An echo done two days prior to the CT showed a focal lesion involving the inter-atrial septum. The cardiac CT shows extensive focal disease in the pericardium (4-chamber view - Fig. 1, short-axis view - Fig. 2). These lesions are necrotic, but show intense, peripheral enhancement. Liver metastases are seen (Fig. 3) with lung metastases (Fig. 4), the lung lesions showing surrounding ground-glass haloes, due to hemorrhage. Spinal, vertebral metastases are noted as well (Fig. 5).