Louisiana Via Research Day Book 2026

Case Studies: Section 2

Case Studies: Section 2

Dipesh Upreti, MD; Niku Thapa, MD; Shekhar Gurung, MD; Ashish Guragain, MD; Navin Ramlal, MD St Francis Medical Center, Department of Internal Medicine 88 RAPIDLY PROGRESSIVE METASTATIC UNDIFFERENTIATED PLEOMORPHIC SARCOMA OF THE LEFT THIGH INVOLVING LUNG AND HEART: A CASE REPORT

Dipesh Upreti, MD 1 ; Niku Thapa, MD 1 ; Hamama Javaid, MD 1 ; Nauman Khalid, MD 2 ; Navin Ramlal, MD 1 1 Department of Internal Medicine, St. Francis Medical Center; 2 Department of Cardiology, St Francis Medical Center, Monroe, Louisiana 89 MYOCARDIAL BRIDGING PRESENTING AS ANGINA WITH NEGATIVE ISCHEMIC WORKUP: A THERAPEUTIC SUCCESS

Introduction: Undifferentiated pleomorphic sarcoma (UPS) is a rare, aggressive soft-tissue malignancy with a high risk of local recurrence and distant metastasis. While lung metastases are common, cardiac involvement is exceedingly rare and portends a poor prognosis. We present a case of metastatic UPS of the thigh with pulmonary and cardiac metastases, highlighting challenges in diagnosis and management. Report of Case: A 57-year-old male with a history of mild Duchenne’s muscular dystrophy presented initially with a painless, enlarging mass in the left anterolateral thigh. Imaging with MRI and biopsy confirmed cT2 G3 undifferentiated pleomorphic sarcoma. The patient underwent radiation therapy. However, a couple of months later, he presented with progressive dyspnea and hypoxia. CT imaging revealed numerous bilateral pulmonary nodules, moderate to large pleural effusions, and echocardiogram showing two right atrial cardiac masses on echocardiogram. Despite palliative interventions, the patient’s condition deteriorated, requiring hospice care.

Discussion: UPS typically metastasizes to the lungs, with cardiac involvement being rare. This case underscores UPS’s aggressive nature and the importance of vigilant follow-up after initial therapy. The rapid progression from localized disease to widespread metastases, including cardiac lesions, illustrates the challenges in managing advanced soft tissue sarcomas. Multimodal imaging was essential in detecting metastatic spread. The patient’s coexisting comorbidities, including mild Duchenne’s muscular dystrophy and diabetes, further complicated treatment options and outcomes. Conclusion: This case highlights the aggressive metastatic potential of UPS and the need for comprehensive surveillance in affected patients. Cardiac metastases, though rare, should be considered in cases of unexplained cardiopulmonary decline. Early recognition and palliative care involvement are crucial in managing advanced disease and optimizing quality of life.

Introduction: Myocardial bridging (MB) is a congenital coronary anomaly characterized by systolic compression of a segment of an epicardial coronary artery, most commonly the left anterior descending (LAD). Although often considered benign, MB can be associated with angina and other ischemic symptoms. We present a case with recurrent chest pain ultimately attributed to myocardial bridging with mild nonobstructive coronary artery disease (CAD), managed successfully with medical therapy. Report of Case: A 64-year-old female with a history of hyperlipidemia, class 2 obesity, and long-standing gastroesophageal reflux disease, presented with recurrent, pressure like chest pain radiating to both arms and the back of her neck, accompanied by shortness of breath, dizziness, nausea, and indigestion. Physical examination was largely unremarkable. Initial workup, including a recent stress test, was negative for reversible ischemia. Cardiac enzymes and electrocardiograms revealed no acute ischemic changes. However, due to the persistence of symptoms, she underwent coronary angiography, which demonstrated

mild (40%) mid-LAD stenosis with evidence of myocardial bridging. The patient was started on calcium channel blockers and beta blockers, with up-titration as tolerated. A repeat coronary angiogram one month later showed significant improvement in the degree of systolic compression and stenosis (reduced to ~20%) in the mid-LAD segment. Her symptoms improved markedly with medical therapy, and she remained chest pain-free on follow-up. The patient continued on aspirin, amlodipine, metoprolol, and Repatha, with outpatient follow-up. Conclusion: This case highlights the importance of considering myocardial bridging as a cause of recurrent angina in patients with otherwise negative ischemic workup. Medical management with beta-blockers and calcium channel blockers can lead to significant symptomatic and angiographic improvement, potentially avoiding the need for invasive intervention.

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2026 Research Recognition Day