Non-diagnosed primary malignant cardiac tumor as a cause of sudden death in a 52-year-old man. A case report with medico-legal implications

We describe the case of a malignant fibrous histiocytoma (MFH) of the heart, presenting with an obstinate cough and clinically misdiagnosed as adult respiratory distress syndrome, in a 52-year-old man. He was diagnosed as pulmonary tuberculosis four years ago. Although his tuberculosis was believed to have cured, he often went to hospital for cough and palpitation. Echocardiogram was conducted only once on the patient four years ago but no abnormalities were found. During the day his condition deteriorated. He went to the emergency department, where he was given intravenous drugs against cough and was sent home. On the way back, his condition deteriorated dramatically so that his son drove back to the emergency room, where he collapsed and sustained cardiac arrest; resuscitation efforts were unsuccessful. Autopsy revealed a large tumor located in the left atrium. Histological and immunohistochemical investigations of the mass established the diagnosis of primary cardiac MFH. Sudden cardiac death, caused by the MFH was ascertained as the cause of death. The morphological and pathological findings are presented, the difficulty to diagnose primary cardiac MFH and the medico-legal implications are discussed.