Abstract
We report a case of progressive respiratory failure secondary to primary cardiac sarcoma masquerading as primary lung disease. An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis. She was treated for primary lung infection without improvement and had respiratory failure with endotracheal intubation by the third hospital day. An “intermediate” plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis. Computed tomography of the chest with intravenous contrast was performed on the fifth hospital day and revealed a cardiac mass. A transthoracic echocardiogram confirmed a large left atrial mass that was obstructing mitral inflow. She was transferred to a tertiary center for emergency cardiac surgery. Primary cardiac tumors are a rare and treatable cause of heart failure in adolescent and young adult patients. Presentation can be confused with primary lung disease and must be suspected early. Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients.
Highlights
IntroductionComputed tomography (CT) of the chest with intravenous contrast was performed on the fifth hospital day and it revealed “(1) bilateral pleural effusions, areas of air space consolidation involving upper and lower lobes
An 18-year-old female with no previous medical history presented to the emergency department with a two-week history of increasing cough, fatigue, dyspnea, and hemoptysis
Computed tomography (CT) of the chest with intravenous contrast was performed on the fifth hospital day and it revealed “(1) bilateral pleural effusions, areas of air space consolidation involving upper and lower lobes
Summary
Computed tomography (CT) of the chest with intravenous contrast was performed on the fifth hospital day and it revealed “(1) bilateral pleural effusions, areas of air space consolidation involving upper and lower lobes. The tumor invades into the atrial myocardium and involves the lateral margins of the atrial tissue present in the specimen) (Figures 4 and 5) The patient was referred for emergency cardiac surgery At operation, she was found to have a large lobulated mass within the left atrium. Separate lesions within the left atrium adherent to the endocardium were sent for pathology
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