Although post-mortem studies would suggest that cardiac
metastases occur frequently, many of these
metastases remain clinically silent. However, symptomatic lesions may also remain unrecognized due to overshadowing by other symptoms of the primary
malignancy. Patients undergoing treatment for
cancer are not routinely screened using echocardiography, unless their chemotherapeutic regimen includes
cardiotoxic agents. The current era of research and development of targeted
biological agents (such as
trastuzumab and
epidermal growth factor receptor inhibitors) for
cancer may lead to prolonged survival of oncology patients. In future,
metastases that were once rare may become increasingly recognized as these new treatments augment the natural history of the disease. There have been several case reports of small, asymptomatic left ventricular
metastases, but clinically significant ventricular
metastases are very rare. There are no reports in the current literature of a symptomatic ventricular
metastasis, occurring in the absence of other metastatic disease. We report an unusual case of a large solitary ventricular
metastasis, leading to
left ventricular outflow tract obstruction and haemodynamic compromise. Echocardiographic imaging led to the diagnosis of a recurrence of soft-tissue
fibrosarcoma 9 years after original resection.