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JAMA Oncology Clinical Challenge
December 2015

Unexpected Cardiac Masses

Author Affiliations
  • 1Department of Internal Medicine, University of Kentucky, Lexington
  • 2Markey Cancer Center, Division of Medical Oncology, University of Kentucky, Lexington
  • 3Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
JAMA Oncol. 2015;1(9):1343-1344. doi:10.1001/jamaoncol.2015.3077

A woman in her 50s presented for evaluation of intermittent epigastric pain, palpitations, and hot flashes for 2 months. The patient had a history of an ovarian cyst treated conservatively, and cosmetic breast augmentation. She had a 10 pack-year smoking history and denied alcohol or illicit drug use. Examination revealed distant heart sounds but otherwise had unremarkable results. An echocardiogram demonstrated a mass in the left ventricular myocardium. Cardiac magnetic resonance imaging was obtained to further assess the mass lesion. This revealed multiple intramyocardial masses involving the left ventricle, the largest of which measured 2.7 × 2.2 cm; aortopulmonary window lymphadenopathy; and moderate pericardial effusion (Figure). Computed tomographic imaging of the chest, abdomen, and pelvis with contrast failed to reveal discrete masses or lymphadenopathy elsewhere. A transcutaneous biopsy of the left ventricular mass was nondiagnostic.