Case Study
An unusual cause of pulmonary edema Adrian Chong, Sudhir Wahi, Ryan Harvey, Chris Finn, Pallav Shah and Paul Gould
Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(3) 338–341 ß The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312470117 aan.sagepub.com
Abstract Primary cardiac tumors are rare malignancies. Patients may present with congestive cardiac failure due to intracavitary obstruction to blood flow, valvular dysfunction, embolic phenomena, local invasion resulting in arrhythmias, pericardial involvement, constitutional symptoms, or paraneoplastic syndromes. We describe the case of a previously fit 79-year-old woman who presented with acute pulmonary edema due to a large left atrial pleomorphic sarcoma causing severe functional mitral stenosis. She underwent palliative debulking surgery with good symptomatic relief.
Keywords Heart atria, heart neoplasms, pulmonary edema, sarcoma
Case report A 79-year-old woman presented after one month of increasing exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. She had a previous thyroid follicular carcinoma and underwent a total thyroidectomy in 2003, with adjuvant radioactive iodine-131 treatment for capsular and vascular invasion. Prior to this, she was diagnosed with primary hyperparathyroidism and underwent a parathyroidectomy in 1973. She had been under surveillance for a monoclonal gammopathy of unknown significance, first diagnosed in 2002. She also suffered from hypertension, hyperlipidemia, vitamin D deficiency, nephrolithiasis, and cholelithiasis. There was no history of cardiac disease. She lived independently and was self-caring. She presented to the emergency department in respiratory distress but hemodynamically stable. Cardiovascular examination revealed an elevated jugular venous pressure and dual heart sounds with no added sounds or murmurs. There were bilateral inspiratory crepitations. She was clinically euthyroid. A 12-lead electrocardiogram confirmed sinus tachycardia with incomplete right bundle branch block. A chest radiograph revealed an increased cardiothoracic ratio, bilateral pleural effusions, and prominent interstitial markings consistent with pulmonary edema. Renal function was mildly impaired (creatinine 81 mmolL 1, estimated glomerular filtration rate 59 mLmin 1), and the total white cell count was elevated at 14.9 (neutrophilia). B-type natriuretic peptide
was elevated at 368 ngmL 1 (normal
An unusual cause of pulmonary edema Adrian Chong, Sudhir Wahi, Ryan Harvey, Chris Finn, Pallav Shah and Paul Gould
Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(3) 338–341 ß The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312470117 aan.sagepub.com
Abstract Primary cardiac tumors are rare malignancies. Patients may present with congestive cardiac failure due to intracavitary obstruction to blood flow, valvular dysfunction, embolic phenomena, local invasion resulting in arrhythmias, pericardial involvement, constitutional symptoms, or paraneoplastic syndromes. We describe the case of a previously fit 79-year-old woman who presented with acute pulmonary edema due to a large left atrial pleomorphic sarcoma causing severe functional mitral stenosis. She underwent palliative debulking surgery with good symptomatic relief.
Keywords Heart atria, heart neoplasms, pulmonary edema, sarcoma
Case report A 79-year-old woman presented after one month of increasing exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. She had a previous thyroid follicular carcinoma and underwent a total thyroidectomy in 2003, with adjuvant radioactive iodine-131 treatment for capsular and vascular invasion. Prior to this, she was diagnosed with primary hyperparathyroidism and underwent a parathyroidectomy in 1973. She had been under surveillance for a monoclonal gammopathy of unknown significance, first diagnosed in 2002. She also suffered from hypertension, hyperlipidemia, vitamin D deficiency, nephrolithiasis, and cholelithiasis. There was no history of cardiac disease. She lived independently and was self-caring. She presented to the emergency department in respiratory distress but hemodynamically stable. Cardiovascular examination revealed an elevated jugular venous pressure and dual heart sounds with no added sounds or murmurs. There were bilateral inspiratory crepitations. She was clinically euthyroid. A 12-lead electrocardiogram confirmed sinus tachycardia with incomplete right bundle branch block. A chest radiograph revealed an increased cardiothoracic ratio, bilateral pleural effusions, and prominent interstitial markings consistent with pulmonary edema. Renal function was mildly impaired (creatinine 81 mmolL 1, estimated glomerular filtration rate 59 mLmin 1), and the total white cell count was elevated at 14.9 (neutrophilia). B-type natriuretic peptide
was elevated at 368 ngmL 1 (normal
