Primary Left-Ventricular Tumor: Presenting as Congestive Heart Failure in an HIV-Positive Young Woman
Year: 2025
Type: article
Abstract: Background: 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. Case Summary: 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. Conclusion: 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.
Authors: Cookey SN, Asikiminabo-Ofori D, Briggs FK, Wakama R, Cookey SA
Language: English
Topic: Cardiac tumors and thrombi
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W6893264196
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