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Case Report: A 73 year old female was admitted to our hospital with complaints of acute shortness of breath on exertion and chest tightness accompanied with non-exertional left arm pain. Her prior history was significant for hypertension. Vital signs were significant for tachycardia. EKG revealed sinus tachycardia and low voltage QRS complexes. Cardiac Biomarkers were negative. CXR on admission showed massive cardiomegaly. (A) Echocardiography, Off Axis, Apical long axis view showing a large mass attached to the LV apex surrounded by large pericardial effusion. Pericardiocentesis was performed and 1200ml of bloody fluid was removed. (B) Cardiac MRI was performed which revealed a mass arising from the inferolateral wall of Left Ventricle measuring 6.5x4.9x6.2 cm Left thoracotomy, wedge biopsy of left ventricular mass was performed. (C, D)Pathological analysis confirmed well differentiated Leiomyosarcoma (grade 1 of 3) FNCLCC grading system. Tumor was strongly positive for vimentin, smooth muscle myosin and desmin.

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