A. A left atrial appendage mass is present, with a large pericardial effusion. 
B, C. An hypermetabolic mass is present in the left atrial appendage extending into the supero-medial left atrium, with SUV_max 5.4. There is a large, partly hypermetabolic, pericardial effusion with SUV_max 4.4. 
D. There is a large hypermetabolic left axillary lymph node with SUV_max 4.3.

Cardiac angiosarcoma.

Primary cardiac tumours are rare. Sarcoma is the commonest primary malignant tumour of the heart, of which angiosarcoma is the commonest subtype. The sarcomas are not morphologically distinctive from their counterparts elsewhere in the body. Tumour rarity, combined with non-specific symptoms such as chest pain, hypotension, tachycardia and malaise, can make diagnosis difficult. Cross-sectional imaging may be used to complement trans-thoracic echocardiography by adding information about tumour size, mobility, location, extent, local invasion, relationship to adjacent structures, distant metastases, and response to treatment. PET/CT enhances the diagnosis of malignancy, with FDG avidity, and has improved accuracy in the diagnosis of metastatic disease, with which up to 80% present. The differential diagnosis in this case would have included infected thrombus or infected valvular vegetation.