Epithelioid angiosarcoma (EA) is an infrequent malignant tumor that has been reported in multiple organs and tissues, including the spleen, kidney, skin, soft tissues, breast, and bones, and reports of mediastinal localization are extremely rare. Herein, a case study is presented of EA in the mediastinum that metastasized to the lungs in a 44-year-old male who presented with hemoptysis. A chest computed tomography scan revealed anterior mediastinal carcinoma with multiple bilateral pulmonary metastases. A needle biopsy of the mediastinum was performed, and histological examination of the specimens showed pleomorphic epithelioid cells with vesicular nuclei, prominent nucleoli, and eosinophilic cytoplasm that lined irregular vascular spaces. In addition, immunohistochemical staining revealed that the tumor cells were positive for CD31, CD34, and vimentin. Based on the histopathological and immunohistochemical findings, the patient was diagnosed with EA. The patient subsequently refused chemotherapy and radiotherapy and succumbed to the disease after one month of follow-up. This case indicates that an early, accurate diagnosis of this disease may improve EA treatment outcomes.