Echo Detects the Unexpected: Tumors, Effusions, and Tamponade

A Case-Based Echo Example

Introduction

Cardiac tumors are rare, but secondary involvement from metastatic disease is far more common than primary cardiac tumors. Metastases reach the heart via hematogenous spread, lymphatic channels, or direct extension from adjacent structures. Echocardiography often serves as the first imaging modality, but distinguishing tumors from thrombus, vegetations, or hypertrophy can be challenging. Recognizing these masses promptly is critical, as they may present with pericardial effusion, heart failure, or arrhythmia, and can significantly impact patient management.

Case Presentation

A patient with a history of lung cancer presented with progressive shortness of breath over several weeks. Transthoracic echocardiography revealed a large circumferential pericardial effusion causing hemodynamic compromise, consistent with tamponade physiology. Further imaging showed a broad-based mass occupying the right ventricular apex, with subtle infiltration of the left ventricular apex. Contrast echocardiography confirmed the mass, which was evident from multiple windows. The patient underwent pericardiocentesis, providing temporary symptom relief. Given his known malignancy, the effusion and tumor were attributed to metastatic spread.