Uncommon Heartache: The Surprising Discovery of a Cardiac Neuroendocrine Tumor in a Young Adult

Abstract

Background: The rare cardiac involvement of neuroendocrine tumors (NETs), uncommon neoplasms with neuroendocrine differentiation that typically arise in the gastroenteropancreatic and pulmonary systems but may present with constitutional symptoms, arrhythmias, thromboembolic events, or hemodynamic compromise depending on tumor size and location. Aims: This report highlights a rare case of cardiac metastasis from a neuroendocrine tumor, emphasizing its diagnostic challenges and important clinical implications. Presentation of Case : We report the case of a 22-year-old male who presented with abdominal distension, dyspnea and significant lower limb edema. Initial investigations revealed a hepatic mass consistent with a neuroendocrine tumor. Further imaging demonstrated an unusual cardiac metastasis located in the right atrium, initially suggestive of a thrombotic process but later confirmed as tumoral extension. The clinical course was complicated by extensive deep vein thrombosis and a right lobar pulmonary embolism. The patient was managed through a multidisciplinary approach considering both oncological and cardiovascular complications. Discussion : Cardiac involvement in neuroendocrine tumors is extremely rare and often reflects advanced disease. The diagnosis may be challenging due to non-specific clinical manifestations and overlap with thromboembolic disease. In this case, the presence of right atrial metastasis associated with thromboembolic complications significantly increased the complexity of management. This highlights the importance of comprehensive imaging and careful evaluation for cardiac involvement in patients with neuroendocrine tumors.particularly to differentiate tumor extension from intracardiac thrombus. Conclusion : This case emphasizes the need to consider cardiac metastasis in patients with neuroendocrine tumors, particularly in the presence of unexplained cardiovascular or thromboembolic manifestations. Early recognition and a multidisciplinary approach are essential to optimize management and improve outcomes.