SHM Converge Scientific Abstract ePoster Gallery-Heart Trouble in Disguise: A Diagnostic Dilemma of Dyspnea Due to a Heart Tumor

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This case highlights the diagnostic challenge of primary malignant cardiac tumors, which are rare and often present with nonspecific symptoms. A 79-year-old man with COPD, Parkinson’s disease, hypertension, hyperlipidemia, and GERD presented after brief chest pain and reported two months of exertional dyspnea that had not improved with steroids or antibiotics. Initial workup showed mild leukocytosis but otherwise normal cardiac and inflammatory labs. CT imaging revealed a moderate-to-large pericardial effusion and emphysema, prompting transfer for further evaluation.<br /><br />At the receiving hospital, transthoracic echocardiography showed only a small pericardial effusion, and cardiac PET CT found no ischemia. However, the CT component suggested loculated fluid in the right pericardial space extending into the mediastinum, which was atypical for a simple effusion. A follow-up chest CT with contrast was interpreted as possible pericarditis, though this did not fit the clinical picture. Because of persistent concern, chest MRI was obtained and revealed a very large enhancing mass arising from the right pericardial space, extending along major mediastinal vessels and compressing the SVC.<br /><br />The patient underwent VATS biopsy, and pathology showed a malignant spindle cell myxoid neoplasm. He was treated with outpatient chemotherapy and later proton radiation therapy, but died about six months after diagnosis on hospice.<br /><br />The case emphasizes that dyspnea may conceal serious cardiac pathology and that a multidisciplinary approach, including radiology, cardiology, pulmonology, and oncology, is essential. It also underscores the limitations of echocardiography alone and the importance of cardiac MRI for defining cardiac mass extent and tissue characteristics.

Asset Subtitle

Bashir Geer

Meta Tag

Author List Bashir Geer, Hyun Kim, Prathima Pangulur

Category Clinical Vignettes

Concept Primary Cardiac Tumor

Concept Malignant Tumor

Concept Transthoracic Echocardiography

Concept Cardiac MRI

Concept Intracardiac Mass

Distinguished Non-Finalist

Presenter Organization Emory University Midtown

Presenting Author Bashir Geer

Track Adult

Keywords

primary malignant cardiac tumor

pericardial effusion

dyspnea

cardiac MRI

mediastinal mass

spindle cell neoplasm

VATS biopsy

superior vena cava compression

echocardiography limitations

multidisciplinary diagnosis

Primary Cardiac Tumor

Malignant Tumor

Transthoracic Echocardiography

Cardiac MRI

Intracardiac Mass