Solitary Right Atrial Metastasis of Chondrosarcoma: A Case Report Highlighting the Role of Multimodality Imaging and Surgical Management

Abstract

Background: Cardiac metastases, though significantly more common than primary cardiac tumors, are a rare clinical finding. Chondrosarcoma, a chemotherapy-resistant malignant bone tumor, exhibits a peculiar propensity for cardiac metastasis, most frequently to the right atrium. Such lesions can lead to catastrophic complications through valvular obstruction, embolization, or arrhythmias, and their management presents a significant therapeutic challenge. Case Presentation: A 68-year-old woman with a history of grade II rib chondrosarcoma resected four years prior, presented with a three-month history of progressive dyspnea, chest discomfort, and peripheral edema. Transthoracic echocardiography identified a large, heterogeneous, mobile mass in the right atrium, causing functional tricuspid stenosis and extending into the right ventricle and superior vena cava. Cardiac magnetic resonance imaging (CMR) characterized the lesion as a well-demarcated, lobulated mass, hyperintense on T2-weighted imaging with intense late gadolinium enhancement. The patient underwent successful complete surgical resection with reconstruction of the atrial wall and tricuspid valve using bovine pericardium. Histopathological analysis confirmed the diagnosis of metastatic chondrosarcoma. Conclusion: This case underscores the critical importance of considering cardiac metastasis in oncologic patients presenting with new cardiovascular symptoms. Multimodality imaging, particularly CMR, is indispensable for tissue characterization and surgical planning. Aggressive surgical intervention remains a viable and potentially life-prolonging treatment option for isolated cardiac metastases, even in the context of metastatic chondrosarcoma, which is notoriously resistant to chemotherapy and radiotherapy.