Left Ventricular Mass in an Oncology Patient and Cocaine User: Metastasis or Thrombus?

Background: Intracardiac thrombus is a common intracardiac mass in patients with left ventricular dysfunction (LVD). Case Summary: A man with a history of malignant melanoma presented with emesis and acute left flank pain. He was found to have a left renal infarct and left ventricle (LV) mass, for which he was started on therapeutic anticoagulation. TTE showed a large, mobile mass measuring 2.5 × 2.0 cm in the LV cavity, with LVD. Cardiac metastasis was suspected, and surgical intervention was planned, but preoperative TEE could not reveal the LV mass seen previously, canceling the planned thoracotomy. Discussion: He had patent coronary arteries; therefore, cardiomyopathy was likely due to cocaine use, which might induce thrombosis within the dysfunctional LV. Medical management with therapeutic anticoagulation, along with guideline-directed medical therapy for LVD, continued.