Multimodality Imaging of Blood Supply in Intramyocardial RCC Metastasis With Double Primary Malignancies
Wanwen Chen1, Minghui Zhang2, Xuhua Jian3
1Department of Echocardiography, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Background:
In patients with multiple primary malignancies, an intramyocardial mass poses a diagnostic challenge when its perfusion pattern deviates from classic metastatic profiles.
Case Summary:
A 58-year-old man with prior renal cell carcinoma (RCC) and nasopharyngeal carcinoma presented with progressive chest distress and dyspnea. Transthoracic echocardiography revealed a 43 × 34 mm right ventricular apical mass supplied by the distal septal branch of the left anterior descending artery. Myocardial contrast echocardiography (MCE) demonstrated delayed filling and slow sustained enhancement. Positron emission tomography/computed tomography showed no systemic disease. Partial resection confirmed metastatic RCC. At the 3-month follow-up, the patient was clinically stable.
Discussion:
This case reveals a discordance between macrovascular and microvascular perfusion, representing an imaging pitfall. MCE excluded thrombus and characterized atypical perfusion. In double primary malignancies, multimodality imaging guided differential diagnosis.
Take-Home Messages:
Transthoracic echocardiography can identify feeding arteries of an intramyocardial mass despite recognized limitations. Atypical perfusion kinetics on MCE does not exclude RCC metastasis; multimodality imaging should be considered in patients with double primary malignancies.
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