Primary Cardiac Undifferentiated Pleomorphic Sarcoma Presenting as Obstructive Shock: Multimodality Imaging Guides Management.

BACKGROUND: Primary cardiac undifferentiated pleomorphic sarcoma is a rare and highly aggressive malignancy. Obstructive shock is an uncommon presentation requiring prompt diagnosis and management. CASE SUMMARY: A 39-year-old woman presented with progressive heart failure that evolved to obstructive shock. Multimodality imaging identified multiple left-sided intracardiac masses involving the left atrium and left ventricle, causing intracardiac obstruction without extracardiac disease. Given refractory hemodynamic compromise, the heart team recommended urgent palliative cytoreductive surgery. Histopathology established the diagnosis of primary cardiac undifferentiated pleomorphic sarcoma. The patient declined adjuvant oncologic therapy and died 3 months after diagnosis. DISCUSSION: This case highlights how multimodality imaging identified the mechanism of obstructive shock and guided urgent therapeutic decision-making. TAKE-HOME MESSAGES: Primary cardiac sarcomas may present with obstructive shock caused by multilevel intracardiac mechanical obstruction. Multimodality imaging clarifies the mechanism of hemodynamic compromise and guides urgent management.