A Rare Manifestation of Cardiac Myeloid Sarcoma

BACKGROUND: Cardiac myeloid sarcoma is a rare hematologic malignancy characterized by myeloid blasts invading cardiac tissue. CASE SUMMARY: A 68-year-old man with myelodysplastic syndrome status post-allogeneic hematopoietic stem cell transplant presented with worsening dyspnea. He was hypoxic but remained hemodynamically stable. Computed tomography angiography chest revealed a large pericardial effusion, and transthoracic echocardiogram confirmed tamponade physiology. The patient underwent an emergent pericardial window, followed by further work-up, including computed tomography, transthoracic echocardiogram, cardiac magnetic resonance, and intracardiac biopsy with novel use of the TLAB device, which identified a right atrial mass consistent with cardiac myeloid sarcoma extending along the interventricular groove with superior vena cava stenosis. DISCUSSION: Cardiac myeloid sarcoma is a rare primary cardiac malignancy with no established treatment guidelines, but multimodal imaging and accurate tissue diagnosis can help tailor therapy. TAKE-HOME MESSAGE: This case report illustrates a rare case of cardiac myeloid sarcoma and demonstrates feasibility of intracardiac biopsy with novel use of a TLAB device.