CTICasesPleomorphic Undifferentiated Sarcoma of the Left Atrium
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Imaging findings
Chest radiograph shows a right unilateral effusion and asymmetric edema with smooth septal thickening, mostly in the right lower lobe, and some ground glass opacity. Coronary CTA initially suggested an extensive mass in the left atrium extending into pulmonary veins, but subsequent MRI clarified that much of this apparent extension was "smoke" or slow-filling contrast due to sluggish flow. MRI showed a mobile, infiltrative mass in the left atrium, originating from the roof rather than the fossa ovalis, transiently narrowing pulmonary veins.
Key takeaways
Cardiac masses can cause asymmetric pulmonary edema due to obstruction of pulmonary venous flow. CT can overestimate the size of cardiac masses due to flow-related artifacts ("smoke"). MRI is often superior for characterizing cardiac masses and assessing infiltration. Primary cardiac sarcomas, unlike myxomas, are often infiltrative and can arise from locations other than the fossa ovalis, presenting with non-specific symptoms like dyspnea and chest pain. This case was a pleomorphic undifferentiated sarcoma.
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