ABSTRACT
Background Large autopsy studies have shown intracardiac metastases in 15% of patients with disseminated cancer. We present a rare case of metastatic squamous cell carcinoma (SCC) of the heart with unknown primary. Case 55-year-old female with DVT, COVID-19 infection and stage IV metastatic SCC of uncertain origin presented with progressive fatigue and dyspnea. She had occlusion of left interlobar pulmonary artery and new large right ventricle (RV) mass consistent with tumor and thrombus invasion. Systemic anticoagulation was initiated. Decision-making Echocardiography showed a large mass in RV measuring 5 cm x 2.5 cm and occupying most of the RV cavity. Though her RV systolic function was reduced, she was unlikely to benefit from surgical resection due to disseminated disease. Piecemeal removal of RV mass alleviated the obstructed RV outflow tract. Histopathology featured squamous cell carcinoma. She had symptom resolution within a week following procedure. The patient was discharged home with oral anticoagulant. On follow up, she had not experienced any worsening of symptoms and changes in RV mass size despite compliance with chemotherapy (carboplatin and paclitaxel) and anticoagulation. Conclusion Metastatic SCC with unknown primary is a rare cause of acute heart failure that highlights the interplay between clinical findings and multimodal cardiac diagnostic imaging. An individualized approach is required for patients, balancing both risks of surgical and percutaneous intervention. [Formula presented]Copyright © 2023 American College of Cardiology Foundation