C48-21 A Rare, Fatal Case of Metastatic Primary Angiosarcoma in a Pregnant Pediatric Patient

Abstract Angiosarcoma is an exceedingly rare and highly aggressive vascular malignancy rarely diagnosed in pediatric and young adult populations. We present a case of metastatic pelvic-primary angiosarcoma in a 16-year-old gravida 1 para 0 female who presented with acute respiratory failure and severe constipation in her third trimester. Her history was significant for vaping and e-cigarette use as well as poor social determinants of health (SDoH). Initial radiography demonstrated numerous nodular pulmonary opacites, but initial bacterial, viral, fungal, and tuberculosis testing was negative. She was ultimately intubated for progressive dyspnea and underwent an emergent cesarean section for deteriorating fetal heart tracings. She began to produce frothy bright-red secretions through the endotracheal tube. Bronchoscopy was significant for diffusely friable airways and yielded progressively bloodier lavage aliquots suggesting diffuse alveolar hemorrhage. Despite broad antifungal and antibiotic coverage and high-dose steroids, her shock worsened. Further radiography demonstrated a large pelvic mass in addition to scattered liver lesions. She developed hemorrhagic shock with increasing intrathoracic pressures on the ventilator. Follow-up chest imaging demonstrated a large heterogenous-appearing right-sided pleural effusion. Pleural hematocrit qualified as a hemothorax and cytology returned with metastatic angiosarcoma. This diagnosis was confirmed with percutaneous biopsy of her liver metastases. Despite aggressive efforts, she ultimately died of progressive shock shortly thereafter. Herein, we report an exceptionally rare presentation of widely metastatic primary angiosarcoma in a young female whose symptoms were masked by pregnancy, further complicating an elusive diagnosis. We seek to expand the limited existing literature, provide insights to inform physicians, and expedite future diagnoses and cares. This abstract is funded by: None