A rare presentation of a soft tissue sarcoma metastasized to the left ventricle

Abstract

Primary cardiac tumors are a rare diagnosis with a reported incidence of 0.001%-0.1% in the general population. They provide adiagnostic challenge as the patients may be asymptomatic or have a wide variety of symptoms. Because of this, cardiac tumorsare often discovered incidentally by imaging modalities or during surgery. Secondary tumors that metastasize to the heart aremore common with an incidence of 0.7%-3.5% in the general population and up to 9.1% in patients with known malignancies. Metastatic tumors most frequently involve the pericardium followed by the epicardium and myocardium. Intracavitary andendocardial metastasis has been rarely described in the literature. We present a case of a patient who had a known soft tissuesarcoma with widespread metastases who presented because of dyspnea. In her workup, a transthoracic echocardiogram revealedan intracavitary mass attached to the left ventricular side of the interventricular septum presumed to be a sarcoma. In ourcomprehensive literature search, a sarcoma has rarely been reported in the left ventricle. We have found that sarcomas that dometastasize to the myocardium often are highly differentiated and carry a poor prognosis. A cardiac tumor may be detected bytransthoracic echocardiogram, transesophageal echocardiogram, magnetic resonance imaging (MRI), computed tomography (CT) or PET scan. The transthoracic echocardiogram is the preferred modality given its availability, cost and portability. Additionalimaging modalities such as contrast echocardiography and MRI can help differentiate cardiac tumors from other cardiac massessuch as thombi or vegetations. Because of the inability to rely on physical signs and symptoms, there must be a high degree ofsuspicion when a patient with known metastatic disease presents with cardiac complaints. It is important for clinicians to beaware of how different imaging modalities can help guide their differential diagnosis of cardiac masses.