Hidden in the Forgotten Ventricle: A Case of Metastatic Lung Cancer Discovered Following Identification of Isolated Right Ventricular Thrombus

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Lung adenocarcinoma is the most common form of primary lung malignancy, especially in those without significant tobacco history. Lung adenocarcinoma is associated with high morbidity and mortality, frequently presenting with nonspecific symptoms and a propensity for thrombosis. CASE 43-year-old male with history of electronic cigarette usage presented for dyspnea and generalized fatigue for 2 weeks. Chest x-ray showed complete opacification of left lung. Bedside echocardiography identified large pericardial effusion with tamponade physiology. Pericardiocentesis yielded 1500cc hemorrhagic fluid, however it did not improve hemodynamic status, and the patient was urgently taken to the operating room for pericardial window and drain placement. Repeat echocardiography demonstrated a newly discovered 2.45 x 1.10 cm right ventricular thrombus without evidence of atrial involvement. DECISION-MAKING Ensuing CT thorax demonstrated bilateral subsegmental pulmonary embolism with an extensive 4.5 x 5.4 cm right upper lobe mass-like lesion. Subsequent cross-sectional imaging identified diffuse metastatic disease involving spine, adrenal and pelvis. Ischial biopsy confirmed adenocarcinoma. The patient was started on apixaban and repeat echocardiogram 4 months later revealed resolution of thrombus. Although lung adenocarcinoma is relatively common, its presentation is heterogenous. Adenocarcinoma frequently predisposes to venous thromboembolism, though this usually involves the right atrium or inferior vena cava; isolated right ventricular localization is atypical. This case highlights the importance of maintaining a broad differential in patients with unexplained isolated right ventricular mass. Delay can increase morbidity and mortality associated with undiagnosed occult malignancy. CONCLUSION This case displays the importance of considering adenocarcinoma in the differential in patients with isolated right ventricular thrombus with or without pericardial effusion. Moreover, the use of multimodal imaging including echocardiography and CT imaging can be pivotal in clarifying cardiac manifestations of locoregional malignancy.

Volume

87

Issue

13 Suppl

First Page

A1863

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1863

DOI

10.1016/j.jacc.2026.02.4640

Link to Full Text

Share

COinS