A woman in her 70s was admitted to our institution with symptoms of transient confusion, aphasia, and right arm weakness. Her medical history was notable for breast cancer (for which she had received chemotherapy in 2001), paroxysmal atrial fibrillation, and a history of pulmonary embolus in 2002 (for which she underwent 3 months of warfarin treatment). She also reported a history of chronic postmenopausal vaginal bleeding due to uterine fibroids. An MRI of the brain revealed a small area of infarct in the left insular cortex/corona radiata. Transesophageal echocardiography revealed normal left and right ventricular (RV) function and a moderate-sized atrial septal defect (ASD) with bidirectional shunt. A CT scan of the abdomen and pelvis revealed a heterogeneously enhancing 25 × 25 × 25 cm pelvic mass of uterine origin, suspicious for leiomyosarcoma (Fig 1).