Intracardiac metastasis of high-grade sarcoma of the neck causing right ventricular outflow obstruction

Description

A 71-year-old man with a medical history significant for high-grade pleomorphic undifferentiated soft tissue sarcoma of the neck and multiple lung metastases presented to the emergency room, with exertional dyspnoea. He was actively receiving palliative radiation at the time of presentation as his tumour was deemed untreatable by his oncologist. Physical examination revealed a cachectic man in mild respiratory distress, at rest. A firm, non-tender 8x8 cm mass was palpated in the suboccipital area of his neck. On auscultation, there were bilateral scattered rhonchi, but no crackles. Cardiovascular examination revealed a grade 3/6 ejection systolic murmur, heard loudest in the pulmonic area, which worsened on inspiration but did not radiate to other areas.

Chest X-ray displayed bilateral pleural effusions and multiple new metastatic lesions, as well as earlier metastatic lesions that were enlarged as compared to those seen on the patient's prior CT chest scans. The initial differential...

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