Rare Right Lung Tumor with Intracardiac Extension: A Case of Successful Multidisciplinary Management

We present a challenging case of a high-grade spindle cell sarcoma originating in the right lung with intracardiac extension to the left atrium and left ventricle via the pulmonary veins, complicated by aorto-iliac thromboembolism. An 18-year-old male presented with sudden-onset bilateral lower limb weakness, low-grade fever, cough, and breathlessness. Computed tomography imaging revealed a large mediastinal mass with intracardiac extension and an infrarenal aortic thrombus. A multidisciplinary team performed a successful single-stage procedure involving excision of the intracardiac tumor via median sternotomy under cardiopulmonary bypass, right pneumonectomy under total circulatory arrest, and bilateral transfemoral embolectomy. Histopathology confirmed a high-grade spindle cell sarcoma with negative surgical margins. This case highlights the importance of a collaborative team approach, vigilant intraoperative monitoring, and the strategic use of circulatory arrest in managing complex thoracic tumors with intravascular extension.