Right Ventricular Metastasis From Rectal Cancer Recurrence

Cardiac metastases from colorectal cancer are exceedingly rare and pose significant diagnostic challenges, particularly in the absence of disseminated disease.

A 55-year-old man with ulcerative colitis and previously treated rectal adenocarcinoma presented with rising carcinoembryonic antigen levels during surveillance. Colonoscopy excluded local recurrence. Multimodality imaging identified a right ventricular mass, with cardiac magnetic resonance revealing a 36 × 48 mm lesion arising from the right ventricular free wall with endoluminal growth and late enhancement. In the absence of extracardiac disease, intracardiac echocardiography-guided endomyocardial biopsy confirmed metastatic colorectal adenocarcinoma.

Endomyocardial biopsy remains the gold standard for definitive etiological diagnosis of intracardiac masses and is generally safe when performed in experienced centers.

Multimodality imaging and operator expertise are essential for accurate diagnosis of high-risk intracardiac masses.