CONGRESS ABSTRACT

Introduction: The detection of an intracardiac mass, particularly a ventricular one, is always a destabilizing and questioning event. In a non-necrotic left ventricle with normal contractility and function, it is likely a tumor; primary cardiac tumors are rare (0.1-0.2% of all tumors), while metastatic tumors are more likely, with total cardiac involvement occurring in up to 14.2% of patients with metastatic tumors, with a minority reaching the myocardium or endocardium and majority the pericardium. The most common metastatic tumors that can involve the heart are melanoma, lung cancer, renal cancer, and lymphoproliferative tumors. Discussion: The case involves a 60-year-old woman who presented to the emergency department due to difficulty walking for groin pain radiating to the lumbar region. Initially, an autoimmune inflammatory disease was suspected, but chest CT revealed an excavated lesion in the left lower lung lobe and multiple pulmonary nodules, leading to a suspected diagnosis of lung cancer. An echocardiogram was initiated for suspected left ventricular thrombosis from chest CT scan revealed a large, oval-shaped, non-protruding, adherent intracardiac mass (5 x 3 cm) originating from the interventricular septum and part of the lateral wall. It was non-pedunculated and had homogeneous echogenicity with a jagged margin for only a short section. Cardiac MRI followed, which in turn confirmed the cardiac mass, suggesting a metastatic nature with the presence of additional secondary atrial tumors. Further investigations documented the presence of brain metastases, for which radiotherapy was undertaken. The diagnosis of lung cancer was confirmed days later by the results of biopsies of lymph nodes in the neck and subcutaneous lesions on the back. Conclusions: This case demonstrates how the onset of cancer can be sneaky, presenting with diverse symptoms and unexpected and surprising involvement of multiple organs. It demonstrates how cardiac involvement is not limited to the most common cardiac tamponade.