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Multimodal Diagnostic Approach in Cardiac Myeloid Sarcomas
1Department of Medicine, Internal Medicine Residency, University of South Florida, Tampa, Florida, USA.
Insights
Cardiac myeloid sarcomas (CMS) are rare but can occur in patients with hematologic malignancies. A multimodal diagnostic approach is crucial for timely diagnosis and management in at-risk populations.
Area of Science:
- Hematology
- Cardiology
- Oncology
Background:
- Myeloid sarcomas are uncommon extramedullary infiltrations of immature myeloid cells.
- These infiltrations are associated with leukemic, myeloproliferative, and myelodysplastic syndromes.
- Cardiac involvement can lead to diverse clinical manifestations depending on the affected cardiac structures.
Observation:
- A 61-year-old male with a history of acute myeloid leukemia, post-hematopoietic stem cell transplant, and prior myeloid sarcomas of the kidney and eye presented with chest pain.
- Electrocardiogram revealed new atrioventricular nodal disease.
- The patient was diagnosed with new cardiac myeloid sarcomas (CMS).
Findings:
- Endomyocardial biopsy is the gold standard for diagnosing cardiac myeloid sarcomas.
- Multiple diagnostic modalities can aid in the detection of CMS.
- Early identification of CMS is critical in patients with hematologic malignancies.
Implications:
- Cardiac myeloid sarcomas, though rare, require a comprehensive diagnostic strategy.
- Prompt diagnosis and management are essential for patients with hematologic malignancies presenting with cardiac symptoms.
- A multimodal approach ensures accurate diagnosis and guides treatment decisions for cardiac myeloid sarcomas.
Background:
Myeloid sarcomas are rare extramedullary infiltrations of immature myeloid cells seen in leukemic, myeloproliferative, and myelodysplastic syndromes. Cardiac infiltration of these cells clinically manifest based on the heart anatomy that is affected.
Case Summary:
A 61-year-old male with significant history of acute myeloid leukemia status post hematopoietic stem cell transplant, left renal myeloid sarcoma status post chemoradiation, and left eye myeloid sarcoma status post chemoradiation was found to have new cardiac myeloid sarcomas (CMS) after presenting with subacute chest pain and new onset of atrioventricular nodal disease on electrocardiogram.
Discussion:
While obtaining an endomyocardial biopsy is the gold standard for diagnosing CMS, multiple diagnostic modalities can be used to determine the presence of them.
Take-Home Message:
While CMS is rare, it is important to follow through with a multimodal diagnostic approach to clarify the diagnosis in the at-risk malignant hematological population when presenting with new or changing cardiac clinical presentations.
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