Metastatic Colorectal Cancer to the Right Ventricle

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide. Cardiac metastasis from CRC is extremely rare with only a few cases reported, with the clinical presentation being silent in over 90% of cases. Here we discuss a case of 62 -year-old male who presented with abdominal pain, distention,and weight loss. Computed Tomography (CT) chest/abdomen showed a multiseptated left hepatic lobe lesion, bilateral lung nodules, and a mass-like hypodensity in the right ventricle (RV). A transesophageal echocardiogram (TEE) confirmed the RV mass with normal cardiac function. A liver biopsy showed metastatic colorectal adenocarcinoma. Two months after diagnosis, the patient developed progressive abdominal distention, shortness of breath, and pedal edema. Hospice care was initiated after he did not tolerate palliative chemotherapy, and he passed away three months later. Metastatic cardiac involvement secondary to CRC is extremely uncommon. From 1948 to 2007, the incidence of cardiac metastasis was noted to be 2.3 - 18.3% in the literature. The clinical presentation is silent in 90% of cases. Symptoms can range from being asymptomatic to chronic fatigue and shortness of breath due to reduced cardiac output, to sudden cardiac death from embolization of metastatic tumor. Metastatic cardiac tumors progress rapidly and have poor outcomes. It is crucial to recognize the underestimated prevalence of cardiac metastasis as it may have implications for the management and prognosis of CRC. Given the asymptomatic presentation of cardiac metastasis in the context of CRC, future integration of genetic sequencing may help delineate further guidelines on screening for cardiac metastasis.