Functional Mitral Stenosis: Imposture of Primary Cardiac Intimal Sarcoma

Figures

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  Figure 1. Electrocardiogram showing normal sinus rhythm with occasional premature ventricular complexes.

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  Figure 2. Computed tomography chest (pulmonary embolism protocol). (a) Small bilateral pleural effusions with diffuse pulmonary edema; (b) normal sized heart without pericardial effusion.

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  Figure 3. Transthoracic echocardiogram showing large mobile density within left atrium. (a) Moving into mitral annulus during diastole; (b) mass seen in left atrium during the systole.

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  Figure 4. Transesophageal echocardiogram showing multilobed mobile large left atrial mass. (a) Mass attached above posterior mitral valve leaflet, which prolapses into left ventricular inflow during diastole; (b) mass seen in the left atrium during systole.

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  Figure 5. Magnetic resonance imaging of myocardium with and without contrast demonstrating characteristics of the mass. (a) Large oval echodensity measuring 4.1 × 3.4 cm visualized within the left atrium on TRU FISP cine imaging, with possible attachment to the posterior mitral leaflet. (b) Isotense on T1-weighed spin echo imaging. (c) No enhancement of mass with first pass of gadalonium. (d) Lack of late gadolinium enhancement of mass.

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  Figure 6. Histopathology pictures of cardiac intimal sarcoma showing cells arranged in spindles with high mitotic activity. (a) H&E stain showing extensive necrosis; (b) H&E stain showing abundant blood vessels; (c) H&E stain showing mitotic activity approximately 3/10 hpf and prominent tissue necrosis; (d) negative tumor margins.