Multimodality Imaging for the Evaluation of an Undifferentiated Pleomorphic Sarcoma Presenting as Cardioembolic Stroke

Abstract

Background. Cancer and ischemic stroke are associated with significant morbidity and mortality. Hypercoagulability, disseminated intravascular coagulation, venous-to-arterial embolism, and non-bacterial thrombotic endocarditis are among recognized mechanisms. Emboli to the brain, or to other organs, are known to occur as a consequence of liberated thrombotic debris originating from the thrombogenic surface of intracardiac neoplastic entities. The most common primary malignancy of the heart is sarcoma; however, masses that occur in the heart are 20 to 40 times more likely as a consequence of metastasis from other sites. Case Report. A 67-year-old woman presented to the emergency room with two brief episodes of dizziness and diplopia for 2 minutes. She had a medical history of provoked upper extremity DVT after a fracture, hypothyroidism, hyperlipidemia, and soft tissue sarcoma. The sarcoma was initially diagnosed in, and subsequently resected from, the right triceps muscle. During posttreatment surveillance, a second lesion was discovered in the left upper pulmonary lobe, and this was also completely resected 9 months following initial diagnosis. We present a case of a woman with a tertiary (cardiac) site sarcoma that presented with embolic stroke. Conclusion. Our case highlights the benefits of multimodality imaging, heart-team approach with oncology support to define anatomy, thereby enable surgical treatment, of a complex intracardiac lesion.