Challenges in Remote Cardiac Care; a Rare Cardiac Tumour

Abstract

Introduction: Synovial sarcoma is a rare soft tissue malignancy that may present with secondary cardiac involvement. Multi-modal imaging is necessary for diagnosis and management requires specialist medical and surgical input. Many Indigenous Australians reside in remote locations with limited services. Accessing necessary healthcare can involve travelling great distances away from family and familiar surroundings. This case report describes a rare case of cardiac tumour with the added challenges faced by an Indigenous patient living in a remote location. Case report: A 52 year old indigenous male presented to an outreach cardiology clinic in a remote community with increasing dyspnoea. A history of synovial sarcoma excision seven years prior was noted. Transthoracic echocardiography revealed a large mass within the left ventricle, extending from the lateral wall, filling a portion of the chamber. The patient subsequently travelled to the closest tertiary hospital, several hundred kilometres away, for further investigation. He was then required to travel interstate for cardiac magnetic resonance imaging (CMR) and consideration of treatment options. The CMR demonstrated findings of malignant tumour invasion of the myocardium, most consistent with metastatic synovial sarcoma. The mass was considered inoperable and the patient was referred back to his closest hospital for palliative treatment closer to his family and community. Conclusion: This report demonstrates a rare case of synovial sarcoma with cardiac metastasis and the imaging modalities involved, as well as highlighting the difficulties faced by those living in remote locations to obtain necessary healthcare.