Intracardiac Thrombi Mimicking Cardiac Metastases in a Patient With Lung Adenocarcinoma

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Right-sided intracardiac thrombi mimicking cardiac metastases in ROS1-positive lung adenocarcinoma and venous thromboembolism (n=1). Intervention: Surgical excision of right atrial mass and therapeutic enoxaparin. Primary outcome: Histopathologic diagnosis of right atrial mass and resolution of right ventricular mass on echocardiography at 1 month.

Q: What does this research mean for the field?

Cancer-associated intracardiac organizing thrombi can mimic cardiac metastases on cardiac magnetic resonance imaging due to overlapping enhancement characteristics, and can be definitively diagnosed by histopathology or resolved with therapeutic enoxaparin. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Maria Lembo; Rosa De Vivo; Lucia La Mura; Beatrice Mauriello; Giuseppe Comentale; Nunzia Cretella; Maria D'Armiento; Cinzia Perrino; Giovanni Esposito; Giuseppe Giugliano

doi:10.1016/j.jaccas.2026.109762

August 8, 2026JACC Case ReportsOpen Access

Intracardiac Thrombi Mimicking Cardiac Metastases in a Patient With Lung Adenocarcinoma

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Why the study?

Differentiating intracardiac thrombi from cardiac metastases is challenging in patients with active malignancy because cancer-associated thrombi can produce overlapping imaging features on cardiac magnetic resonance.

Key Points

To describe the diagnostic challenge of distinguishing hypercoagulability-related intracardiac thrombi from cardiac metastases in a patient with active lung adenocarcinoma.
Clinical evaluation of a 50-year-old man with ROS1-positive lung adenocarcinoma and two persistent right-sided intracardiac masses despite therapeutic anticoagulation.
Diagnostic workup included transthoracic echocardiography, cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and T1/T2 mapping, surgical excision of the right atrial mass, and immunohistochemical analysis.
Cardiac magnetic resonance demonstrated low T1 signal, mildly increased T2 signal, elevated T2 mapping values, and heterogeneous late gadolinium enhancement in both a 20 × 34 mm right atrial mass and an 18 × 25 mm right ventricular mass.
Histopathology of the resected atrial mass revealed organizing fibrin and inflammatory cells with negative immunohistochemical staining for calretinin, cytokeratin 7, and thyroid transcription factor-1, confirming an organizing thrombus.
Following treatment with enoxaparin (8,000 IU twice daily), follow-up transthoracic echocardiography at 1 month showed complete resolution of the remaining right ventricular mass.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 50-year-old man with venous thromboembolism and newly diagnosed ROS1-positive lung adenocarcinoma who developed two persistent right-sided intracardiac masses, followed for 1 month post-surgery.

I

Intervention

Surgical excision of the right atrial mass followed by high-dose subcutaneous enoxaparin 8,000 IU twice daily for 1 month (after initial failure of fondaparinux 7.5 mg daily, rivaroxaban 20 mg daily, and intravenous unfractionated heparin for 10 days alongside entrectinib).

O

Outcome

Histopathologic diagnosis of the excised right atrial mass and complete resolution of the remaining right ventricular mass on transthoracic echocardiography at 1 month follow-up.surrogate

Cancer-associated intracardiac thrombi can exhibit heterogeneous late gadolinium enhancement and elevated T2 signal on cardiac magnetic resonance that mimic cardiac metastases, requiring histopathologic confirmation or empiric anticoagulation follow-up when imaging and clinical context are discordant.

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Implication

Persistent right heart masses in cancer may represent thrombi rather than metastases; leaves open refined CMR criteria and anticoagulation protocols.

Abstract

CASE SUMMARY: A 50-year-old man with venous thromboembolism and newly diagnosed lung adenocarcinoma developed 2 right-sided intracardiac masses that persisted despite therapeutic anticoagulation. Findings on cardiac magnetic resonance raised concern for cardiac metastases. Histopathologic examination of the excised atrial mass demonstrated organizing thrombus, and the remaining ventricular lesion resolved after 1 month of therapeutic enoxaparin. TAKE-HOME MESSAGES: Cancer-associated intracardiac thrombi may mimic metastatic disease on cardiac magnetic resonance because their fibrin-rich and inflammatory composition can produce overlapping imaging features. When imaging and clinical findings are discordant, histopathologic confirmation may be required for definitive diagnosis and management.

Discussion

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Cite This Study

Lembo et al. (2026) conducted a case report in Right-sided intracardiac thrombi mimicking cardiac metastases in ROS1-positive lung adenocarcinoma and venous thromboembolism (n=1). Surgical excision of right atrial mass and therapeutic enoxaparin was evaluated on Histopathologic diagnosis of right atrial mass and resolution of right ventricular mass on echocardiography at 1 month.

synapsesocial.com/papers/6ad0fc8615427f6a8404023d https://doi.org/10.1016/j.jaccas.2026.109762

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Intracardiac Thrombi Mimicking Cardiac Metastases in a Patient With Lung Adenocarcinoma

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Intracardiac Thrombi Mimicking Cardiac Metastases in a Patient With Lung Adenocarcinoma

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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