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An Absolute Obstacle: Cardiac Metastasis of Synovial Sarcoma

Published:January 27, 2014DOI:https://doi.org/10.1016/j.amjmed.2014.01.005
      Bilateral swelling of the lower extremities, a 25-lb (11.3-kg) weight gain, and abdominal distension were grim heralds for a 44-year-old man. He presented with a 2-month history of these symptoms but denied shortness of breath, orthopnea, chest pain, palpitations, or syncope. Two years earlier, the patient had been diagnosed with synovial sarcoma of the right shoulder, for which he underwent preoperative radiation, local resection, and chemotherapy. A year after the initial diagnosis, he required further chemotherapy for biopsy-proven metastatic disease to his lungs. His second course of treatment was complicated by glomerulonephritis from Henoch-Schönlein purpura and a central-catheter-related deep vein thrombosis of the upper extremity that required 6 months of anticoagulation. From that point on, he suffered from stage III chronic kidney disease and severe thrombocytopenia.
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