Cardiac tumors constitute a minority of openheart
surgery cases. Primary cardiac tumors are
generally benign and most frequently diagnosed as
myxoma.[
3] Metastatic cardiac tumors are usually
diagnosed at postmortem autopsy. The most
common tumors that metastasize to the heart are
lung cancers, breast cancers, and hematological
malignancies.[
4] Osteosarcomas rarely metastasize
to the heart. Osteosarcoma cases with cardiac
metastasis are rare in the literature. There is a
limited number of primary cardiac osteosarcoma
cases.[
5-
7] Intracardiac metastatic osteosarcoma cases
can be asymptomatically diagnosed during the
follow-up. Additionally, it can be the first symptom
of recurrence.[
8,
9] Symptoms are completely related to
the affected chamber of the heart. The most common
symptoms are shortness of breath, weakness, and
fatigue. Rarely, it may present as peripheral arterial
recurrent embolism.[
7] The primary osteosarcoma
site may be the lower or upper extremities. Due
to the low number of cases in the literature, the
most common origin of metastasis is not known.
However, cardiac metastasis originating from femur
osteosarcomas is more frequently encountered in
the literature.[
8,
10] There is no clear ratio concerning
metastatic heart tumors. However, metastasis to
the right heart chambers is more common in the
literature.[
8-
11] In our case, there was spread to the
right chambers of the heart and superior and inferior
cava. There are also publications regarding the
invasion of the left chambers of the heart.[
6,
12] Patients
are generally young females and adolescents. After
the primary diagnosis, early cardiac metastasis may
occur, or metastasis may be seen after many years
from diagnosis.[
11] There was a three-year period
between primary diagnosis and cardiac metastasis
in our case. Magnetic resonance angiography, CTA,
ventriculography, transthoracic echocardiography,
and transesophageal echocardiography can be used
for diagnosis in symptomatic patients. Positron
emission tomography and scintigraphy can be
used in asymptomatic patients.[
9] In our case, the
patient was diagnosed by CTA. However, CTA
images appeared more compatible with intracardiac
thrombus. In our case, the diagnosis of metastatic
osteosarcoma was made based on intraoperative findings and pathology. The main treatment is
the surgical resection of the tumor. After surgical
treatment, chemotherapy, radiotherapy, or combined
treatments can be applied with a multidisciplinary
approach. All osteosarcomas with cardiovascular
metastasis in the literature were electively operated.
However, our patient was urgently operated due to
severe dyspnea and respiratory distress, impaired
laboratory values, and hemodynamic instability.
Although there are tumors that metastasize to the
cardiovascular system, they rarely require emergency
surgery. There are no intracardiac metastatic
osteosarcoma cases requiring urgent surgery in the
literature.
In conclusion, although rare, metastatic intracardiac
tumors may require emergency surgery. In such cases,
a fast and effective preoperative preparation can
prevent undesirable results.
Patient Consent for Publication: A written informed
consent was obtained from patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Design, writing the article and,
analysis: F.A.; Literature review and references: V.P.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.