A 62 year-old man with non-ischemic cardiomyopathy was admitted for worsening shortness of breath and lower extremity swelling. DVT was ruled out on bilateral duplex ultrasound. The transthoracic echocardiogram showed a large heteroechogenic mass in the left ventricle, raising the possibility of intra-cardiac tumor. MRI was contraindicated due to AICD.

FDG PET-CT was performed and demonstrated a large photopenic defect corresponding to the relatively homogenous hypodensity in the left ventricle, consistent with an intracardiac thrombus. The patient was treated for his CHF exacerbation and referred for heart transplant evaluation.

Intra-cardiac mass is a rare and serious condition. Imaging has an essential role in identifying the etiology. MRI has been successfully used to evaluate intra-cardiac masses including thrombi (1). FDG PET-CT has also been used to evaluate benign and malignant cardiac tumors presenting as an intracardiac mass (2-5). Compared to MRI, PET-CT is not limited by the presence of AICDs or metallic prosthesis. In addition, a negative PET-CT exam carries a very high negative predictive value to rule out primary or metastatic cardiac tumor.

1: Barkhausen J, Hunold P, Eggebrecht H, Schüler WO, Sabin GV, Erbel R, Debatin JF. Detection and characterization of intracardiac thrombi on MR imaging. AJR Am J Roentgenol. 2002 Dec;179(6):1539-44.

2: Gates GF, Aronsky A, Ozgur H. Intracardiac extension of lung cancer demonstrated on PET scanning. Clin Nucl Med. 2006 Feb;31(2):68-70.

3: Kim JH, Jung JY, Park Y, Hwang SI, Jung CS, Lee SH, Yoo CW. Non-small cell lung cancer initially presenting with intracardiac metastasis. Korean J Intern Med. 2005 Mar;20(1):86-9.

4: Bittner HB, Sharma AD, Landolfo KP. Surgical resection of an intracardiac rhabdomyoma. Ann Thorac Surg. 2000 Dec;70(6):2156-8.

5: Agostini D, Babatasi G, Galateau F, Grollier G, Potier JC, Bouvard G. Detection of cardiac myxoma by F-18 FDG PET. Clin Nucl Med. 1999 Mar;24(3):159-60.

This case was prepared by Dr. David He BCM