A 44-year-old man was hospitalized after a syncopal episode. A thrill and loud systolic ejection murmur were present over the left border of the sternum. A 12-lead ECG and chest x-rays were normal. A 2D echocardiogram and Doppler studies documented normal cardiac chambers and a peak systolic pulmonary transvalvular gradient of 80 mm Hg. Biplane right ventriculography revealed a large mobile mass in the main pulmonary artery extending into the right ventricular outflow tract ( Figure 1 ).

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... MRI showed the mass within the same area ( Figure 2 and Figure I, which can be found at www.circulationaha.org). The patient underwent surgical resection of a large tumor in the main pulmonary artery (Figure 3) . The tumor extended into the right pulmonary artery. The pulmonary valve was replaced with a homograft, and an endarterectomy of the main and right pulmonary arteries was accomplished. Histological examination revealed a spindle cell sarcoma (Figures 4 and 5) . The patient remained asymptomatic and had no cardiac murmurs 8 months after surgery. 1 Reference 1. Bleisch N, Kraus F. Polypoid sarcoma of the pulmonary trunk. Cancer. 1980;46:314. Figure 1. Biplane right ventriculography reveals a large mobile mass in the main pulmonary artery that extends into the right ventricular outflow tract (arrow). Figure 2. MRI taken before (left) and after (right) administration of gadolinium. Images were obtained in the right ventricular outflow tract projection. A large, enhancing mass (arrows) is present in the main pulmonary artery and upper outflow tract.