PMC4990053_01
MRI brain 2013.
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April 2013 when a 15-year-old girl presented to her local accident and emergency department with a two-month history of an occipital headache, three weeks of intermittent diplopia and a one-week history of vomiting on multiple occasions daily. An insightful emergency doctor ordered an MRI scan with IV contrast that was performed the same day (Figure 1).
PMC4990053_02
2015 CT thorax with contrast.
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It showed a 4.6 x 3.5 x 3 cm filling defect in the left atrium (Figure 2).
2013 CT thorax with contrast.
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The radiologist compared this to the 2013 CT scan and noted that it was present at that time, although only measuring 2 x 2 x 1.6 cm at that time (Figure 3).
Cardiac MRI 2015.
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Five days later, a cardiac MRI scan was performed showing a tumour mass attached to the posterior wall of the left atrium lying very close to but not occluding the left lower pulmonary vein (Figure 4).
Surgery 2015.
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The mass was clearly causing obstruction of inflow into the mitral valve and she therefore underwent urgent resection the following morning (Figure 5).
Specimen 2015.
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The 8.5 x 4.5 x 4 cm specimen (Figure 6) was identified as a high-grade pleomorphic undifferentiated sarcoma with MDM2 amplification suggesting that it was an intimal sarcoma.