Uterine leiomyosarcoma is an uncommon malignant neoplasm that frequently metastasizes through the bloodstream to distant organs such as the lung, bone, and brain. We report on and discuss a patient who had sudden onset of acute heart failure with pulmonary edema and bilateral pleural effusions, resulting from a high-grade uterine leiomyosarcoma metastatic to the left atrium. Surgical removal of the tumor terminated the acute heart failure and pulmonary edema. Other unusual features of this case include the metastatic leiomyosarcoma to the left atrium with expression of acute heart failure and the pulmonary tumor lesion obscured by the shadows of pleural effusion, pulmonary edema, and the breast.