CTICasesLeft Lung Cancer with Direct Intravascular Extension and Tumor Thrombus
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Imaging findings
Chest CT and cardiac MRI demonstrate a large right atrial mass that prolapses through the tricuspid valve into the right ventricle, with tumor thrombus extending continuously through the superior vena cava and brachiocephalic vein. On MRI, delayed enhancement sequences with varying inversion times (300 ms vs 600 ms) help differentiate tumor from simple thrombus; the mass does not invert at 600 ms but does at 300 ms, confirming soft tissue tumor. PET-CT shows intense FDG avidity of the intravascular and intracardiac mass, which is contiguous with a large, primary left apical lung mass.
Key takeaways
Intravascular tumor thrombus extending into the superior vena cava and right heart is a known but rare complication of advanced lung cancer. Cardiac MRI with delayed enhancement imaging at varying inversion times is highly effective for distinguishing solid, vascularized tumor (which typically inverts around 300 ms) from avascular clot (which inverts around 600 ms).
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