Authors
Wanwen Chen, Minghui Zhang, Xuhua Jian, Oudi Chen
Published in
JACC. Case reports. Pages 110741. Sep 29, 2026. Epub Sep 29, 2026.
Abstract
In patients with multiple primary malignancies, an intramyocardial mass poses a diagnostic challenge when its perfusion pattern deviates from classic metastatic profiles.
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.
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.
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.
PMID:
42886132
Bibliographic data and abstract were imported from PubMed on 16 Oct 2026.
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