Abstract
A 50 year-old woman presented with dyspnoea and symptoms and signs of systemic venous congestion. Examination revealed murmur of pulmonary stenosis. Echo-Doppler, CT scanning and Magnetic Resonance Imaging showed a large right ventricular tumour obstructing the right ventricular outflow tract. She had a hysterectomy for menorrhagia 9 years previously, and resection of a lump involving the right trapezius a month prior to her deterioration. Pathology demonstrated low-grade endometrial stromal sarcoma. She deteriorated acutely in hospital due to pulmonary embolism from superimposed thrombosis. Anticoagulation, followed by radiotherapy resulted in marked clinical improvement. Two years later, the patient remains well. Cardiac metastasis from ESS is rare. Diagnosis is established by echocardiography, CT and cardiac MRI, which allow structural and functional evaluation of the tumour. MRI seems to be the most useful modality. Treatment is palliative or curative resection. This is the first case report of cardiac ESS showing good response and prolonged survival after radiotherapy. Prophylactic anticoagulation should be considered as pulmonary embolism can cause marked deterioration.
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