Key result
Multimodality imaging effectively identifies rare intramyocardial renal cell carcinoma metastasis to guide management.
Why the study?
In patients with multiple primary malignancies, intramyocardial masses with atypical perfusion patterns pose diagnostic challenges requiring multimodality imaging for accurate characterization.
Case Report (n=1)
Atypical perfusion kinetics on myocardial contrast echocardiography do not exclude metastasis, and multimodality imaging is crucial for evaluating intramyocardial masses in patients with double primary malignancies.
Answers are grounded in this paper and cite their sources.
Atypical MCE perfusion does not exclude metastasis; leaves open multimodality imaging protocols for intramyocardial masses in patients with multiple malignancies.
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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Chen et al. (2026) conducted a case report in Intramyocardial RCC Metastasis With Double Primary Malignancies (n=1). Multimodality imaging (echocardiography, MCE, PET/CT) and partial resection was evaluated on Diagnostic characterization and clinical stability. Multimodality imaging successfully characterized an atypical intramyocardial renal cell carcinoma metastasis in a 58-year-old man, guiding differential diagnosis and leading to clinical stability.
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