Confounding clinical picture in the diagnosis of left ventricular and valvular masses: a case report

Area of Science:

• Cardiology
• Oncology
• Diagnostic Imaging

Background:

• Cardiac masses present a diverse differential diagnosis, including infections, rheumatic conditions, and primary or metastatic tumors.
• Accurate diagnosis hinges on characterizing the mass's location, shape, origin, and integrating clinical context.
• This case details the diagnostic process for a cardiac mass, focusing on a rare secondary metastatic tumor in the left ventricle.

Observation:

• A 69-year-old female with a history of metastatic lung and breast cancer presented with dyspnea and fever.
• Transthoracic echocardiogram (TTE) revealed a mobile, echo-lucent mass in the left ventricle (LV) and masses on the mitral and tricuspid valves.
• Initial assessment considered infective endocarditis and benign pathologies.

Findings:

• Cardiac magnetic resonance imaging (MRI) demonstrated a broad-based mass invading the LV lateral wall with delayed gadolinium enhancement, highly suggestive of metastatic malignancy.
• The echocardiographic findings were atypical for the final diagnosis.
• The patient received aspirin for embolization prevention and subsequently hospice care.

Implications:

• Atypical cardiac masses visualized on TTE necessitate further investigation.
• Cardiac MRI is crucial for definitive diagnosis when echocardiographic findings and clinical presentation are discordant.
• This case underscores the importance of considering metastatic disease in cardiac mass evaluation, particularly in patients with a history of cancer.