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A 65 year old man was admitted for evaluation of recent onset of weight loss and heart murmur. Physical examination revealed a regular heart rate of 62 beats/min and a blood pressure of 110/70 mm Hg. On cardiac auscultation, a grade 4/6 systolic murmur was heard over the region of the pulmonic valve. Electrocardiography showed low voltage. Chest radiography showed normal cardiac configuration and no pulmonary abnormality was seen.
An oesophagogram and endoscopy showed an uncreative and infiltrative oesophageal cancer, which was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography was performed (panel A). Histologically, the cardiac tumour was proven to have the same pathologic findings as an oesophageal cancer, compatible with carcinomatous metastasis (panel B). Interestingly, the feeding vessel in the mass was identified by echocardiography (panel C) and confirmed by coronary angiography (panel D).