Unusual echocardiographic appearance of a cardiac metastasis from lung carcinoma

During hospitalization in the Oncology Department, a woman with nonsmall cell lung cancer and no previous cardiac event complained of episodes of chest pain and palpitations. Preliminary instrumental examinations diagnosed atrial fibrillation in pericarditis. A subsequent complete transthoracic echocardiogram showed the presence of a large mass involving the left ventricular apex, without echo-contrast enhancement. A thoracic CT with iodized contrast agent revealed its necrotic composition and was concluded as cardiac metastasis. This is an unusual case of a malignant neoplasm showing no contrast enhancement at echocardiogram because of its necrotic composition, mimicking a thrombus. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:392-394, 2016.