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.