Case 7: Multiple Intracardiac Masses Associated with Renal Cell Carcinoma (Back to Indications for Cardiovascular MRI)

This ~40 year old male was suffering from terminal widely metastatic renal cell carcinoma despite aggressive chemotherapy. He was transferred to the ICU for possible pulmonary emboli. Intracardiac masses were detected by echocardiography during the evaluation of new supraventricular arrhythmias.

The MRI was used to better characterize the intracardiac masses. At least 4 distinct masses were seen in the right atrium, body of the right ventricle, and the right ventricular outflow tract. The intraventricular septum appears flattened in systole consistent with right ventricular pressure overload. The pre-contrast images show a large mass in the right ventricle with uniform signal intensity.

After gadolinium contrast, the renal cell carcinoma appears to enhance while there is a rim of tissue that remains quite dark on the surface. We hypothesize  that the tumor had an irregular surface that served as a nidus for a large thrombus (dark after contrast). Surgical or autopsy confirmation is not available in this case.

Pre-Contrast Images	After Gadolinium Contrast