Angiosarcomas are primary vascular malignancies with a highly invasive character. The lung is the most common site of metastasis, but primary pulmonary angiosarcomas are rarely reported. We reported a case of suspicious primary pulmonary angiosarcoma with the initial presentation of bilateral lung nodules and pericardial effusion. Diagnosis was made by surgical biopsy via thoracoscopy. The clinical characteristics, histopathologic features and treatment options were also reviewed in this article.