Silent Metastasis of Myxoid Liposarcoma to the Heart Unveiled by Multimodal Imaging

We present the case of a 58-year-old male with a history of smoking and hypertension, who was diagnosed with and treated for a myxoid liposarcoma of the right thigh. After undergoing surgical resection with negative margins and adjuvant radiotherapy, the patient remained asymptomatic. During a scheduled two-year routine imaging follow-up, a suspicious mass was identified in the right ventricle, incidentally detected on a surveillance scan without preceding clinical symptoms, leading to the diagnosis of metastatic cardiac myxoid liposarcoma. Multimodal imaging, including echocardiography, CT scan, and cardiac MRI, provided crucial insights into the tumor's characteristics. CT detected the lesion and its anatomical localization. MRI confirmed its lipomatous composition and helped exclude differentials. Echocardiography assessed intracardiac involvement and hemodynamic impact. Surgical resection of the cardiac mass confirmed the diagnosis after histopathologic examination. Despite successful treatment, the patient later died from a myocardial infarction secondary to coronary artery disease, which was not linked to the tumor or surgical events. This case highlights the rarity and diagnostic challenges of metastatic cardiac liposarcoma and emphasizes the role of advanced imaging and surgical intervention in its management.