Sinister syncope.

Abstract

ischemic necrosis of multiple loops of small bowel with evidence of pan-jejunal and ileal pneumatosis. He was urgently referred for exploratory laparotomy, superior mesenteric embolectomy, and extensive small bowel resection. Pathologic specimen revealed malignant tumor cells present within thrombus material, consistent with tumor emboli. Cardiac magnetic resonance imaging of the intracardiac mass revealed intramuscular invasion of the tumor without extension beyond the cardiac borders (Figure 3). Intraoperative transesophageal echocardiography (Figures 4 and 5, Supplementary Video 1 to be found online at http://informahealthcare.com/doi/abs/ 10.3109/17482941.2014.911916) revealed a large mass with highly mobile components, with no other cardiac tumor noted. Eventual wide resection of the intracardiac tumor, which required partial myomectomy and mitral valve replacement due to its extensive nature, revealed a poorly diff erentiated malignant neoplasm with an extensive