Massive Biventricular Thrombosis in a Case of Metastatic Lung Cancer

An 80-year-old male patient with rheumatic heart disease, bio-prosthetic aortic valve, stage IV non-small cell lung cancer, and brain metastases presented with progressive shortness of breath and worsening pleural effusions. He had no history of systemic embolization and was not on anticoagulation. On exam, he was hemodynamically stable at presentation with an elevated jugular venous pressure and bilateral pedal edema. Transthoracic echocardiographic imaging revealed the presence of new onset severe cardiomyopathy with an ejection fraction of 30% and global hypokinesis.

Video 1

Two-dimensional imaging of the apical four-chamber view demonstrating large biventricular thrombi with mobile components.

Video 2

Inversed apical four-chamber view on transthoracic echocardiogram with contrast to better characterize intra-ventricular thrombi. The left ventricle is shown on the left side in the clip.

What is your diagnosis based on the imaging?

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