Osteosarcoma in a Young Patient: When the Tumor Reaches the Heart

Cardiac metastases from osteosarcoma are exceedingly rare and often diagnosed late, representing a major diagnostic challenge.

A 17-year-old boy with a history of osteosarcoma presented with dyspnea and palpitations. Transthoracic echocardiography revealed a mobile intracardiac mass attached to the tricuspid subvalvular apparatus with partial right ventricular outflow tract obstruction. Cardiac magnetic resonance demonstrated a lesion with heterogeneous signal intensity and late gadolinium enhancement, suggestive of malignancy. Surgical resection was performed, and histopathology confirmed metastatic osteosarcoma.

This case highlights the importance of multimodality imaging in the evaluation of intracardiac masses and underscores the need to consider cardiac metastasis in patients with advanced malignancy and atypical cardiac symptoms.