Investigations
Initial Laboratory workup and chest x-ray were unremarkable (Table 1). TTE demonstrated a 4.16 x 2.5 cm mass attached to the apical septum of the left ventricle with echogenicity similar to the myocardium and smooth borders which partially enhanced with perflutren sonographic contrast (Figure 1).
Cardiac magnetic resonance imaging (MRI) was done to further evaluate and characterize the mass. Cardiac MRI revealed an apical mass of the left ventricle measuring approximately 4 cm with probable extension outside of the expected left ventricular cavity with imaging features most compatible with soft tissue tumor, potentially containing internal fat (figure 2). A Positron Emission Tomography–Computed Tomography (PET/CT) demonstrated a mixed density mass in the apical region of the left ventricle with mildly increased FDG uptake with SUV max of 2.4, with the size of the mass measuring 2.6 x 2.4 x 3.7 cm (figure 3). It also demonstrated markedly enlarged fibroid uterus with focal intense radiotracer uptake. A subsequent pelvic MRI confirmed the numerous large uterine fibroids.