Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
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Case Report

Volume 9, Number 5, October 2018, pages 307-313

Functional Mitral Stenosis: Imposture of Primary Cardiac Intimal Sarcoma

Figures

Figure 1.
Figure 1. Electrocardiogram showing normal sinus rhythm with occasional premature ventricular complexes.
Figure 2.
Figure 2. Computed tomography chest (pulmonary embolism protocol). (a) Small bilateral pleural effusions with diffuse pulmonary edema; (b) normal sized heart without pericardial effusion.
Figure 3.
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.
Figure 4.
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.
Figure 5.
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.
Figure 6.
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.

Table

Table 1. Initial laboratory results
 
Complete blood count
  White blood cells10.7 × 103/cmm (4.4 × 103 - 9.7 × 103/cmm)
  Hemoglobin12.5 g/dL (13.2 - 17.4 g/dL)
  Red blood cells3.86 mil/cmm (4.22 - 5.8 mil/cmm)
  Hematocrit37.6% (39.6-50.7%)
  Platelet count302 thou/cmm (150 - 370 thou/cmm)
  Mean corpuscular volume97.4 fl (80 - 100 fl)
  Mean corpuscular hemoglobin concentration33.2% (31.9-35.6%)
  Red cell distribution width12.4% (11.8-14.5%)
  Mean corpuscular hemoglobin32.0 pg (27.4 - 32.8 pg)
Basic metabolic panel
  Serum sodium141 mEq/L (136 - 145 mEq/L)
  Serum potassium3.4 mEq/L (3.5 - 5.1 mEq/L)
  Serum chloride104 mEq/L (98 - 107 mEq/L)
  Serum bicarbonate28 mEq/L (21 - 32 mEq/L)
  Serum creatinine0.88 mg/dL (0.67 - 1.17 mg/dL)
  Blood urea nitrogen16 mg/dL (7 - 18 mg/dL)
  Blood glucose133 mg/L (70 - 99 mg/dL)
  Serum calcium9.1 mg/dL (8.5 - 10.1 mg/dL)
  Serum magnesium2.1 mEq/L (1.5 - 2 mEq/L)
  Anion gap12 mEq/L (8 - 16 mEq/L)
Hepatic panel
  Aspartate aminotransferase26 IU/L (5 - 30 IU/L)
  Alanine aminotransferase22 IU/L (5 - 30 IU/L)
  Total bilirubin18 µmol/L (2 - 20 µmol/L)
  Direct bilirubin2 µmol/L (0 - 6 µmol/L)
  Serum albumin4 g/dL (3.5 - 5.5 g/dL)
  Total protein7.5 g/dL (6 - 8.3 g/dL)
Cardiac markers
  Creatinine kinase28 U/L (25 - 200 U/L)
  Creatinine kinase-MB22 IU/L (5 - 25 IU/L)
  Serum troponin (initial on presentation)< 0.015 ng/mL (0.015 - 0.045 ng/mL)
  Serum troponin (second at 3 h)< 0.015 ng/mL (0.015 - 0.045 ng/mL)
  Serum troponin (third at 6 h)< 0.015 ng/mL (0.015 - 0.045 ng/mL)