Renal cell carcinoma with cardiac metastasis and near right heart obliteration: A case report

Abstract

Renal cell carcinoma (RCC) is the most common type of primary kidney cancer with up to 30 % of patients having metastatic disease at the time of diagnosis. Metastasis to the heart is extremely rare with only a few cases ever reported. Most patients with cardiac metastases of any origin do not develop symptoms of cardiac dysfunction. The classic triad of presentation for RCC is hematuria, flank pain, and a palpable mass. We report a rare occurrence of cardiac involvement of RCC infiltrating both the right atrium and right ventricle in an otherwise healthy female patient whose presenting symptom was dyspnea. Dyspnea, although a vague presenting symptom with a large differential diagnosis, is the most common presenting symptom of cardiac tumors and a sudden presentation of dyspnea in a patient with RCC should encourage the consideration of cardiac metastasis. The importance of repeat imaging and cross-disciplinary care in a patient with RCC with cardiac involvement is well displayed. A delay in cancer diagnosis may lead to delay in therapy and the result may be associated with significant morbidity and mortality. Quick action including evaluation and treatment for RCC is imperative to increase the chance for survival.

Learning objective

Metastasis to the heart is extremely rare and most patients do not develop cardiac symptoms. Dyspnea is a vague presenting symptom requiring a broad differential to determine underlying pathology. Here, acute dyspnea in a patient with renal cell carcinoma was the presenting symptom of cardiac metastasis and continued repeat imaging in this patient with supplemental oxygen requirements showed fast spread into the right heart.