Primary Cardiac Leiomyosarcoma

Abstract

A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …