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

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. 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.