Characterization of Cardiac Sarcoma With 2- and 3-Dimensional Echocardiography, Myocardial Contrast Echocardiography and Cardiac Magnetic Resonance Imaging

Abstract

A 57-year–old woman had previously undergone a right hemicolectomy for Duke B adenocarcinoma of caecum. She presented with acute back pain. A magnetic resonance imaging scan of her thoracic spine showed destruction of a vertebra with a tumor deposit at T11 (Figure 1A). She underwent a course of radiotherapy (20 Gray in 5 fractions) to this area. Good symptomatic relief was obtained. Biopsy demonstrated a sarcomatoid tumor suggestive of leiomyosarcoma. Over the next 2 months she developed dyspnea on exertion, fatigue, and leg edema. Examination revealed a regular tachycardia, raised jugular venous pressure, and bilateral leg edema. On auscultation, an added early diastolic sound (consistent with tumor plop) was audible. A 3-dimensional echocardiogram identified a large mass protruding from the right atrium into the right ventricle (Figure 1B and online-only Data Supplement Movie I). The mass prolapsed through the tricuspid valve into the right ventricle during diastole, intermittently obstructing right ventricular inflow and almost completely occluding the tricuspid valve …