Primary cardiac sarcoma presenting with easy bruising: a case report

Abstract

Background: Primary cardiac sarcomas are rare, aggressive types of malignancies with poor prognoses and can rarely present with thrombocytopenia. Sarcomas account for 65% of primary malignant cardiac tumours. Clinical symptoms often present with constitutional symptoms such as shortness of breath, weight loss, and fatigue. In addition, the tumour's location determines treatment options and prognosis. Multimodal imaging facilitates the detection and assessment of cardiovascular tumours. This case study presents a rare primary right heart cardiac sarcoma presenting with thrombocytopenia.

Case summary: An 80-year-old male presented to the emergency department with complaints of worsening dyspnoea, ease of bruising, and chest pain. An extensive investigation into the cause of thrombocytopenia was performed. A transthoracic echocardiogram, computed tomography scan, and cardiac magnetic resonance (CMR) image revealed a large mass affecting the right atrium and right ventricle. Myocardial biopsy showed high-grade angiosarcoma. Due to his advanced age and intraventricular septal involvement of the mass, the multidisciplinary team decided to proceed with palliative chemotherapy.

Discussion: Many cardiac tumours remain asymptomatic, and the diagnosis is made at an advanced stage of the disease. Differential diagnoses of the intramural masses include haemangiomas, lipomas, rhabdomyomas, lymphomas, and sarcomas. Multiple treatment options should be considered to address thrombocytopenia. Tumour diagnosis and identification consist of laboratory tests and multimodal imaging. Complete surgical resection with neoadjuvant and adjuvant purposes is the mainstay of cardiac sarcoma therapy. A multidisciplinary, individualized care approach should be performed.

Keywords: Case report; Primary cardiac sarcoma; Thrombocytopenia; Transthoracic echo.

Figure 1

Transthoracic echocardiogram revealed poorly separated from the interventricular septum mass, which completely obliterated the right ventricular cavity and extended into the right atrium. TTE 4-chamber view showing right atrium mass. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle. White arrow shows intraventricular mass.

Figure 2

Cardiac magnetic resonance imaging images showing mass obliterating the right ventricular cavity and extending into the right atrium. (A) Sagittal magnetic resonance imaging image of the right ventricular mass with extension into the right atrium. (B) Coronal magnetic resonance imaging image of the right ventricular mass with extension into the right atrium and interventricular septum.

Figure 3

Cardiac magnetic resonance imaging video—four chamber FIESTA imaging revealed an 11.5 cm × 5.1 cm × 4.8 cm mass within right ventricle centred on the basal intraventricular septum. Mass fills the right ventricle cavity, extends through the tricuspid valve into the right atrium, invading the myocardium of the intraventricular septum and right ventricular free wall.