Large Obstructive Cardiac Myxofibrosarcoma Is Nearly Invisible on Transthoracic Echocardiogram

Abstract

Malignant primary cardiac tumors are exceptionally rare, and the most common of these are sarcomas. We present a case of a patient who was found to have a large mass in the left atrium causing obstruction of mitral inflow. Only selected views on a transthoracic echocardiogram reveal the mass and its hemodynamic effect. Although the mass was sizeable, it could be easily overlooked on cursory review of the echocardiogram. After surgical resection, the mass was proven to be a myxofibrosarcoma. We review the etiologies and possible solutions for the imperfect sensitivity of transthoracic echocardiography for cardiac masses.

A Primary Left Atrial Leiomyosarcoma Mimicking Myxoma: Echocardiographic Findings

“…Although we misdiagnosed this case as benign tumor, there were important clues for a differential diagnosis. In most reported cases of misdiagnosis, cardiac magnetic resonance imaging is recommended for additional structural and functional assessment 9 . If there is a high level of suspicion, multimodality images would be helpful for tissue characterization and to show invasiveness of the tumor, preoperatively.…”

Left Ventricular Myxoma: Case Report

“…The findings on the echocardiogram help not only the detection of the tumor, but the hemodynamic evaluation, mobility, consistency and to assess the base of the tumor as well [2,16].…”

Myxofibrosarcoma: Cytomorphologic Findings and Differential Diagnosis on Fine Needle Aspiration

“…MFS classically presents superficially in the lower extremities, followed by the trunk, upper extremities, neck, and head [1,8,9,10], but it has also been reported superficially in the breast [11,12], perineum [13], and orbit [14,15]. Reports also exist of MFS in deep sites, including the esophagus [16], hypopharynx [17], vocal fold [18], parotid [19], heart [20,21,22], aorta [23], pulmonary artery [24], lung [25] and brain [26,27]. …”