Primary Cardiac Intimal Sarcoma Visualized on 2-[¹⁸F]FDG PET/CT

Area of Science:

• Cardiology
• Oncology
• Radiology

Background:

• Primary cardiac tumors are rare, with malignant forms, particularly sarcomas, having a poor prognosis.
• Cardiac intimal sarcoma, an endocardial mesenchymal tumor, is exceptionally rare and often presents aggressively.
• Timely diagnosis and intervention are critical for managing primary cardiac sarcomas.

Purpose of the Study:

• To report a rare case of cardiac intimal sarcoma presenting as massive intracardiac masses.
• To illustrate the utility of hybrid imaging in characterizing cardiac tumors and assessing tumor burden.
• To highlight the importance of early diagnosis and surgical intervention for primary cardiac sarcomas.

Main Methods:

• Case report of a 60-year-old male with a history of congenital aortic stenosis.
• Utilized hybrid imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) for tumor characterization.
• Surgical resection was the primary treatment modality.

Main Results:

• The patient presented with functional mitral stenosis/insufficiency and left ventricular outflow tract obstruction due to large cardiac masses.
• 2-[18F]FDG PET/CT helped characterize the intracardiac masses and estimate tumor burden.
• Surgical resection with achievement of free margins was the mainstay of treatment.

Conclusions:

• Cardiac intimal sarcoma is a rare and aggressive malignancy requiring prompt diagnosis and treatment.
• Hybrid imaging plays a vital role in the preoperative assessment of cardiac tumors.
• Multidisciplinary management, including surgical resection, is essential for improving outcomes in patients with primary cardiac sarcomas.