case_images: PMC11733539_01
case_images: Melanoma Metastasis to the Heart. (A) First electrocardiogram. Sinus rhythm with signs of left ventricular hypertrophy and negative T waves on the inferolateral leads. (B and C) First cardiac magnetic resonance, short-axis and 2-chamber view cine magnetic resonance, showing an interventricular and apical cardiac mass with hypersignal (yellow arrows and red arrows, respectively). (D) Cardiac magnetic resonance, native T1 sequence, showing a septal mass (yellow arrow) with high intensity signal (longer T1 relaxation time). (E) Cardiac magnetic resonance, T2 sequence, showing a septal mass (yellow arrow) with prolonged relaxation time. (F) Cardiac magnetic resonance, showing a septal mass with mild peripheral enhancement after gadolinium administration (yellow arrow). (G) Positron emission tomography with computed tomography. A cardiac mass (yellow arrow) showing behavior suggestive of metabolic aggressiveness (hyperenhancement with a central hypometabolic area compatible with central necrosis). Multiple pulmonary nodules suggestive of malignancy (red arrows) are present. (H) Second electrocardiogram. Normalization of the repolarization anomalies. (I and J) Second cardiac magnetic resonance, short-axis and 2-chamber view cine magnetic resonance, where we can see a reduction in cardiac mass size.
case_images: gr1.jpg
case_images: PMC11733539_01_gr1.jpg
case_images: fig1
case_images: The electrocardiogram (ECG) showed sinus rhythm with deep negative T waves in the inferior and precordial leads (V4-V6) (Figure 1A). A transthoracic echocardiogram showed a bulky mass occupying the interventricular septum, and this mass (5 cm x 6 cm)was confirmed by a cardiac magnetic resonance (CMR) imaging study (Figures 1B and 1C, Videos 1 and 2). CMR confirmed the presence of a septal mass, with hypointense signal in T1, prolonged relaxation time in T2, and mild peripheral enhancement after gadolinium administration (Figures 1D to 1F). Positron emission tomography with computed tomography was performed, without a hint of an evident primary tumor (Figure 1G). After 12 months of follow-up, the ECG normalized, and the cardiac mass was drastically reduced in size (Figures 1H to 1J, Video 3).