Cardiac Biventricular Metastasis From Renal Cell Carcinoma

Secondary cardiac tumors are much more common than primary tumors. Cardiac metastases from renal cell carcinoma (RCC) are rare and can present many years after the patient has been disease-free. We report the case of a 64-year-old man who had been treated for recurrent metastatic RCC. He presented with shortness of breath, and TEE (transthoracic echocardiography) revealed new biventricular hypertrophy and small-to-moderate circumferential pericardial effusion. Cardiac magnetic resonance demonstrated multiple lesions in both the ventricular walls, highly suspicious for metastasis. A tissue biopsy was obtained, which was inconclusive due to the small sample size. The patient's disease progressively worsened, and, subsequently, he died from cardiac and respiratory failure secondary to the underlying advanced metastatic disease. Cardiac metastasis from RCC is rare and has a wide range of presentations. Metastatic RCC tends to be resistant to chemotherapy and radiotherapy. Systemic therapy (immunotherapy, molecularly targeted agents) and surgery may have a role in these patients depending on the extent of disease and sites of involvement.