Primary Cardiac Synovial Sarcoma Misdiagnosed as Tuberculoma

Abstract

Primary cardiac synovial sarcoma is a rare tumor found in the heart. It is most commonly seen in young adults. In this section, we will describe a case of primary cardiac synovial sarcoma that was misdiagnosed as a tuberculoma by the care team. The patient presented with nonspecific worsening dyspnea and fatigue for 2 weeks. She was 31 years old and had a history of weight loss. The patient was living with her brother who was getting treated for pulmonary tuberculosis. The patient herself was not on any prophylactic medications. A pericardial effusion was seen on X-ray and a pericardiocentesis was subsequently performed. Laboratory examination revealed a lymphocytic predominant pericardial fluid. However, evidence of malignancy was not present in the sample. Echocardiogram demonstrated a right atrial mass which was diagnosed as a tuberculoma. Tuberculoma was considered because the patient was exposed to tuberculosis from her brother. Cardiac magnetic resonance imaging confirmed the presence of a mass measuring 39 mm × 28.5 mm. Biopsy obtained from surgery demonstrated monophasic cardiac synovial sarcoma. Transesophageal echocardiogram was never obtained. Accurate guidelines are not available for treatment of primary cardiac synovial sarcoma, and extensive research is needed. The extremely rare incidence makes it challenging for such research to take place. The patient died because of a cardiac tamponade secondary to the synovial sarcoma.