The Diagnostic and Therapeutic Dilemma of Multiple Left Ventricular Masses

Intracardiac masses are rare and potentially life-threatening entities with diverse clinical presentations. The prompt identification of cardiac masses is critical. However, even with the advancement we have in imaging modalities, diagnosing cardiac masses remains a formidable challenge. Herein, we present the case of a 62-year-old female who presented with a three-week history of dyspnea and chest pain. Further workup revealed elevated troponins, thrombocytosis, and ST-segment elevation in the anterolateral leads. Chest CT revealed a concerning lung mass, along with vertebral lesions and a large pleural effusion. The patient underwent treatment for suspected myocardial infarction. Additional imaging identified five intracardiac masses in the left ventricle suspicious for either malignancy or thrombi. High-intensity heparin drip was started, yet the patient developed neurological symptoms. Neuroimaging showed new cerebral infarcts. Based on the patient and her family's wishes, the patient transitioned to comfort care and passed away from gastrointestinal bleeding. In our case, the patient's presentation raised questions about whether her intracardiac masses were malignant or thrombotic. The decision to initiate and maintain anticoagulation therapy constitutes a debate, emphasizing the need for an individualized approach and shared decision-making with the patient and the multidisciplinary team.