Angiosarcomas are rare, highly aggressive neoplasms originating from vascular or lymphatic endothelium [1]. Cutaneous angiosarcoma of the scalp has a predilection to involve pleural/subpleural surfaces [2,3]. Able to induce pneumothorax, hemothorax, and pleural effusion, few reports link angiosarcoma of the scalp to cystic lung disease [3]. Herein, we present a case of cutaneous angiosarcoma of the scalp associated with cystic lung disease and hydropneumothorax.

Partial anomalous pulmonary venous connection (PAPVC) is a process where one or more, but never all, pulmonic vein(s) connect with the great vessels or veins destined for the right atrium of the heart. Postulated as relatively benign, patients with isolated communicates are predominantly asymptomatic with no need for intervention [1]. The degree of abnormality or long-standing PAPVC may yield volume overload and eventual cardiopulmonary insufficiency [2]. Such sequelae are demonstrated in the proceeding case. CASE PRESENTATION:A 62-year-old man with a PMH of COPD was transferred to our care for the evaluation of recurrent exacerbation of right-sided heart failure refractory to medical therapy. Upon transfer, he endorsed dyspnea and prior episodes of bilateral lower extremity pain/swelling. Prior treatment with diuretics provided no relief. On investigation, TTE demonstrated an EF of 52%. TEE revealed right-heart systolic dysfunction with increased volume and pressures in both chambers. Cardiac catheterization confirmed such findings, additionally demonstrating pulmonary arterial hypertension. Left-sided angiography displayed direct drainage of left upper pulmonary vein into the left innominate vein, confirming PAPVC. Balloon occlusion test confirmed the lack of an alternative drainage source, such as an accessory vein, in the left upper lobe. Such presentation permitted permanent occlusion of the causative pulmonary vein via a vascular plug and delivery system. Post-occlusion, normal right-heart pressures were recorded. Venography of anomalous vein confirmed successful occlusion.Post-occlusion imaging and catheterization recorded normal atrial pressures with an absence of right heart strain. Once presenting as recurrent CHF refractory to medication, the patient now continues to do well, with low-dose diuretics adequately managing his heart failure.