Key result
Multimodality imaging incidentally detects a probable metastatic RVOT mass in an asymptomatic gastric adenocarcinoma patient.
Why the study?
Probable metastatic cardiac involvement from gastric adenocarcinoma may rarely present as a clinically silent right-sided cardiac mass involving the RVOT and right ventricular free wall.
Case Report (n=1)
Highlights the utility of multimodality imaging in baseline cardio-oncology assessments for incidentally detecting and characterizing clinically silent cardiac metastases.
Silent RVOT mass may signal metastatic gastric cancer; leaves open prevalence and imaging protocols in cardio-oncology.
Background: Probable metastatic cardiac involvement from gastric adenocarcinoma may rarely present as a clinically silent right-sided cardiac mass involving the right ventricular outflow tract (RVOT) and right ventricular free wall. Case Summary: A 60-year-old man with newly diagnosed metastatic gastric adenocarcinoma underwent baseline cardio-oncology assessment prior to chemotherapy. Transthoracic echocardiography revealed a large heterogeneous RVOT mass (3.1 × 2.0 cm) with preserved left ventricular systolic function (LVEF 50-55%) and no significant obstruction (peak gradient 16 mmHg). Transoesophageal and three-dimensional echocardiography demonstrated a sessile, non-pedunculated lesion with broad-based attachment. Cardiac magnetic resonance imaging showed an infiltrative mass with heterogeneous late gadolinium enhancement, with imaging features highly suggestive of metastatic involvement. A catheter-associated thrombus served as an internal comparator. The patient remained asymptomatic and proceeded to systemic therapy. Discussion: This case illustrates an uncommon pattern of probable metastatic cardiac involvement presenting as a right-sided cardiac mass involving the RVOT and right ventricular free wall, detected incidentally in an asymptomatic patient. It further shows that baseline cardio-oncology imaging, performed for pre-treatment cardiovascular assessment, may incidentally identify clinically relevant structural abnormalities. Multimodality imaging supported characterization of the lesion and helped guide management.
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Shirini et al. (2026) conducted a case report in Metastatic gastric adenocarcinoma (n=1). Multimodality imaging was evaluated. Multimodality imaging incidentally detected a 3.1 × 2.0 cm probable metastatic right ventricular outflow tract mass in an asymptomatic 60-year-old man with metastatic gastric adenocarcinoma.
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