SHM Converge Scientific Abstract ePoster Gallery-A Rare Cardiac Tumor Presenting as Flank Pain

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This case report describes a 22-year-old previously healthy man who presented with sudden-onset left flank pain after shoveling, along with mild dyspnea, fever, tachycardia, and leukocytosis. Initial CT abdomen/pelvis was interpreted as showing a striated nephrogram consistent with pyelonephritis, and he was treated accordingly.<br /><br />However, the key diagnostic issue was the hyperacute tempo of symptoms, which did not fit pyelonephritis well. The hospital medicine team independently reviewed the imaging in light of this discordance and considered renal embolism with infarct instead. This broader reasoning led to transthoracic echocardiography, which revealed a large mass in the left ventricular cavity. Cardiac MRI further defined the lesion as a large LV mass extending along the papillary muscle and mitral valve. Biopsy confirmed primary cardiac synovial sarcoma, a very rare and aggressive cardiac tumor.<br /><br />The case highlights two major lessons. First, clinicians should prioritize disease tempo in diagnostic reasoning: sudden, vascular-type presentations should prompt consideration of embolic phenomena, even when initial imaging appears to support a more common diagnosis. Second, imaging should be reviewed independently through the lens of the clinical story, rather than accepted at face value. Here, that approach helped recognize that the kidney findings likely reflected infarction rather than infection, preventing the cardiac tumor from being missed.<br /><br />Overall, the report emphasizes that diagnostic reasoning is a dynamic, non-linear process in which integrating clinical context with imaging interpretation can reveal serious alternative diagnoses and improve patient care.

Asset Subtitle

Ellie Garbade

Meta Tag

Author List Ellie Garbade, Megan E. Betancourt

Category Clinical Vignettes

Concept Disease Tempo

Concept Diagnostic Reasoning

Concept Intracardiac Mass

Concept Hyperacute Symptoms

Concept Imaging Study

Distinguished Non-Finalist

Presenter Organization University of Rochester Medical Center

Presenting Author Ellie Garbade

Track Adult

Keywords

renal infarction

pyelonephritis

cardiac synovial sarcoma

left ventricular mass

embolic phenomenon

hyperacute flank pain

diagnostic reasoning

cardiac MRI

transthoracic echocardiography

striated nephrogram

Disease Tempo

Diagnostic Reasoning

Intracardiac Mass

Hyperacute Symptoms

Imaging Study