Left Atrial Undifferentiated Pleomorphic Sarcoma Causing Mitral Valve Obstruction

Abstract

A 61-year-old Latino woman with no past medical history presented to the emergency department with 2 weeks of gradual onset of dyspnea on exertion, cough, and palpitations. She denied any recent illnesses, fevers, or unintentional weight loss. She was not taking any medications or using tobacco, alcohol, or illicit drugs. On physical examination, she had a temperature of 100.6°F, a heart rate of 122 bpm, respiratory rate of 25 breaths per minute, blood pressure of 155/92 mm Hg, and oxygen saturation of 92% on bilevel positive airway pressure. Her physical examination was notable for jugular venous distension, a loud S1 and normal S2, a grade 2/6 middiastolic murmur heard loudest at the apex, crackles throughout her posterior lung fields, and trace bilateral lower-extremity edema. Her ECG showed sinus rhythm with no significant ST-T abnormalities (Figure 1). A portable chest radiograph showed mild enlargement of the cardiac silhouette, bilateral air space opacities, and small bilateral pleural effusions (Figure 2). Computed tomography of the chest with intravenous contrast was done to evaluate for pulmonary embolism; it revealed a mass with lobulated margins within the left atrium (Figure 3) protruding into the left ventricular cavity and infiltrating the left atrial wall. Figure 1. Twelve-lead ECG demonstrating normal sinus rhythm with no significant ST-T segment abnormalities. Figure 2. Portable chest radiograph showing mild enlargement of the cardiac silhouette, bilateral air space opacities, and small bilateral pleural effusions. Figure 3. A …