Left Ventricular Sarcoma Causing Dynamic Outflow Tract Obstruction and Cardiogenic Shock: A Case Report

TL;DR

A rare case of left ventricular sarcoma causing life-threatening heart obstruction and shock is reported, highlighting the importance of early echocardiography for diagnosis and treatment.

Contribution

This case report presents a rare clinical scenario of dynamic LVOT obstruction due to primary cardiac sarcoma, emphasizing the role of bedside echocardiography in timely diagnosis.

Findings

A 33-year-old male with progressive dyspnea and hemoptysis was found to have a large intracardiac mass causing LVOT obstruction.

Urgent surgical intervention confirmed an infiltrative cardiac sarcoma with positive margins.

Prompt diagnosis via echocardiography and early surgical resection led to favorable postoperative recovery.

Abstract

Primary cardiac sarcomas are rare and aggressive tumors that often present with nonspecific symptoms, typically diagnosed at advanced stages. Obstruction of the left ventricular outflow tract (LVOT) due to these tumors is an exceptionally rare and life‐threatening complication.

We describe the case of a previously healthy 33‐year‐old male who presented with progressive exertional dyspnea, orthopnea, and hemoptysis. Upon admission, he quickly developed hemodynamic instability and respiratory failure. Point‐of‐care transthoracic echocardiography revealed a large intracardiac mass causing dynamic LVOT obstruction. During intubation, the patient experienced cardiac arrest, necessitating advanced cardiopulmonary resuscitation. Urgent surgical intervention confirmed the presence of an infiltrative cardiac sarcoma with positive margins. The postoperative recovery was favorable, enabling extubation and withdrawal of vasoactive agents within 24 h.

Cardiac sarcomas often mimic other cardiovascular conditions, complicating early diagnosis. Imaging techniques such as echocardiography and cardiac MRI are essential for detection and characterization. The prognosis for patients with cardiac sarcomas remains poor due to the tumors′ infiltrative nature and high rates of recurrence; however, complete surgical resection is the cornerstone of treatment.

This case underscores the necessity for clinical vigilance in patients presenting with unexplained cardiopulmonary symptoms. The early application of bedside echocardiography facilitated prompt diagnosis and timely surgical intervention, proving life‐saving in this instance of obstructive shock due to a primary cardiac sarcoma.

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