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Contribution of contrast echocardiography to the differentiation between a thrombus and a tumorous mass in end-stage lung carcinoma

A 36-year-old man, with end-stage small cell lung cancer (SCLC), was evaluated for atypical chest pain. The transthoracic echocardiography (TTE) study showed a mass in the right ventricle (figure 1). The left and right ventricular contractility were good. There was no pericardial effusion. The nature of the mass was uncertain. Given the history of SCLC, there was suspicion for cardiac metastasis, although there was no pericardial effusion to support this diagnosis. An intracardiac thrombus could be due to the hypercoaguable state in patients with cancer, although the right ventricular contractility was good and there were no structural abnormalities with increased risk of cloth formation. TTE was not diagnostic in this patient. As there were no curative options, only diagnostic procedures with a minimal risk seemed to be justified. Contrast echocardiography (CE) showed colouring of the right ventricular mass, proving vascularity (figure 2). Thus, the diagnosis of an intracardiac neoproliferative process was made.