Primary Left-Ventricular Tumor: Presenting as Congestive Heart Failure in an HIV-Positive Young Woman
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| author | Cookey SN Asikiminabo-Ofori D Briggs FK Wakama R Cookey SA |
| author_facet | Cookey SN Asikiminabo-Ofori D Briggs FK Wakama R Cookey SA |
| contents | <p><strong><span>Background:</span></strong><span> Cardiac involvement is detected in up to two-thirds of people living with HIV on echocardiography, with pericardial effusion, diastolic dysfunction and dilated cardiomyopathy topping the list of structural lesions. In Nigeria, Cookey, reported cardiac abnormalities in 63 % of asymptomatic PLWHA, with pericardial effusion as the most prevalent (44.5 %). Although primary cardiac tumours are exceptionally rare (≈0.02 % at autopsy), malignant sarcomas may mimic heart-failure phenotypes, especially when diagnostic resources are limited.</span></p> <p><strong><span>Case Summary:</span></strong><span> A 29-year-old woman on tenofovir/lamivudine/efavirenz presented with jaundice 4weeks after commencement of antiretroviral which included effivarenz, progressive dyspnoea, orthopnoea, night sweats and pedal oedema. Examination revealed cachexia, raised jugular venous pressure and bibasal crackles; blood pressure was 100/60 mm Hg and heart rate 112 bpm. Point-of-care transthoracic echocardiography uncovered a lobulated, echogenic mass that appeared in direct continuity with the infero-media LV wall. Its echogenicity mirrored adjacent myocardium, it displayed no “echo-smoke,” and it moved synchronously—not flail—with ventricular contraction. Marked regional hypokinesia of the involved wall reduced biplane LVEF to 35 %. The constellation made mural thrombus unlikely and raised strong concern for a primary cardiac sarcoma masquerading as congestive heart failure. Advanced imaging and biopsy were planned, but the patient absconded against medical advice before definitive work-up.</span></p> <p><strong><span>Conclusion:</span></strong><span> This vignette underscores the need for high clinical suspicion and immediate bedside imaging when we are caring for PLWHA in refractory heart failure. Recognition of tumor-like features—tissue-matched echogenicity, wall continuity and absence of spontaneous contrast—can steer clinicians away from empirical anticoagulation toward urgent cardio-oncology referral, even in resource-constrained settings.</span></p> |
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| publishDate | 2025 |
| publisher | Zenodo |
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| spellingShingle | Primary Left-Ventricular Tumor: Presenting as Congestive Heart Failure in an HIV-Positive Young Woman Cookey SN Asikiminabo-Ofori D Briggs FK Wakama R Cookey SA <p><strong><span>Background:</span></strong><span> Cardiac involvement is detected in up to two-thirds of people living with HIV on echocardiography, with pericardial effusion, diastolic dysfunction and dilated cardiomyopathy topping the list of structural lesions. In Nigeria, Cookey, reported cardiac abnormalities in 63 % of asymptomatic PLWHA, with pericardial effusion as the most prevalent (44.5 %). Although primary cardiac tumours are exceptionally rare (≈0.02 % at autopsy), malignant sarcomas may mimic heart-failure phenotypes, especially when diagnostic resources are limited.</span></p> <p><strong><span>Case Summary:</span></strong><span> A 29-year-old woman on tenofovir/lamivudine/efavirenz presented with jaundice 4weeks after commencement of antiretroviral which included effivarenz, progressive dyspnoea, orthopnoea, night sweats and pedal oedema. Examination revealed cachexia, raised jugular venous pressure and bibasal crackles; blood pressure was 100/60 mm Hg and heart rate 112 bpm. Point-of-care transthoracic echocardiography uncovered a lobulated, echogenic mass that appeared in direct continuity with the infero-media LV wall. Its echogenicity mirrored adjacent myocardium, it displayed no “echo-smoke,” and it moved synchronously—not flail—with ventricular contraction. Marked regional hypokinesia of the involved wall reduced biplane LVEF to 35 %. The constellation made mural thrombus unlikely and raised strong concern for a primary cardiac sarcoma masquerading as congestive heart failure. Advanced imaging and biopsy were planned, but the patient absconded against medical advice before definitive work-up.</span></p> <p><strong><span>Conclusion:</span></strong><span> This vignette underscores the need for high clinical suspicion and immediate bedside imaging when we are caring for PLWHA in refractory heart failure. Recognition of tumor-like features—tissue-matched echogenicity, wall continuity and absence of spontaneous contrast—can steer clinicians away from empirical anticoagulation toward urgent cardio-oncology referral, even in resource-constrained settings.</span></p> |
| title | Primary Left-Ventricular Tumor: Presenting as Congestive Heart Failure in an HIV-Positive Young Woman |
| url | https://doi.org/10.5281/zenodo.15786065 |