a 70-year - old male who complained of cough and palpitation persisting for 2 weeks visited samsung medical center . seven years previously , he had undergone wide excision surgery of the right buttock area for rhabdomyosarcoma ( about 4 cm ) . although he received adjuvant chemotherapy following the surgery , rhabdomyosarcoma recurred in the left hip 4 years later . a transesophageal echocardiogram showed an oval - shaped mass at the chorda of the anterior mitral valve ( fig . 1 ) , which was thought to be a metastasis of rhabdomyosarcoma , vegetation , thrombus , or a primary tumor . positron emission tomography / computed tomography ( pet / ct ) showed no distant metastasis of the primary rhabdomyosarcoma at the but - tock . to further evaluate the tumor , coronary ct angiography and cardiac magnetic resonance imaging ( mri ) were performed ; the images showed a 13-mm mass attached to the basal anterolateral left ventricle ( lv ) wall ( fig . his vital signs were stable except for arrhythmia , and the laboratory results were within normal limits . we planned to perform a surgical resection of the cardiac mass and a maze operation for arrhythmia . the surgery progressed under general anesthesia with the patient in the supine position , and a standard median sternotomy and conventional cannulation were performed . the left atrium was incised , and a mass on the lv anterolateral wall was observed through the mitral valve ( fig . 3 ) , and a modified cox maze iii procedure was performed with cryoablation . upon pathological examination , the patient was diagnosed with metastatic rhabdomyosarcoma . one month after the operation , his thigh mri showed tumor recurrence at the left thigh . three months later , a follow - up in the outpatient department revealed that his rhythm still maintained a normal sinus and was hemodynamically stable . although primary cardiac tumors are rare , with the autopsy incidence ranging from 0.001% to 0.03% , cardiac metastases are not as low as expected and range from 2.3% to 18.3% . with the exception of mesothelioma , which leads to cardiac metastasis more often in men ( 57.3% ) than in women ( 30% ) , cardiac metastases are equally present in both sexes . in our patient , the clinical symptoms of cardiac metastasis are variable , and these tumors often go unrecognized in vivo until after the patient s death . in the case of secondary tumors located in the myocardium , the clinical pattern is typically proportional to the degree of myocardial infiltration or is related to the wall infiltration site . a typical presentation includes arrhythmias such as atrial flutter or fibrillation , premature beats or ventricular arrhythmia , conduction disturbances , and complete atrioventricular blocks , particularly if the conduction system has been infiltrated . we first performed transesophageal echocardiography because of the atrial fibrillation presented by the patient , and this method was shown to be helpful for tumor diagnosis in our patient . chest ct and mri with enhancement are also helpful imaging modalities to evaluate tumors because they show tumors as contrast - enhanced masses ; these imaging modalities also evaluate the adjacent organs for metastasis and seeding . surgical management is generally critical for secondary cardiac tumors , as the metastases are often neither solitary nor confined to the heart . nevertheless , resection may be considered in individual cases if no other organs are involved , and the tumor can be removed completely . in our case , laboratory values measuring inflammation were within normal limits , so the possibility of infective endocarditis was low . however , we decided on surgical resection because the patient complained of palpitations and the pet / ct results confirmed that no other organs were involved . the operation was successful , as indicated by the clear resection margin and the absence of further symptoms . thus , in this paper , we report a rare case of metastatic cardiac rhabdomyosarcoma .
a 70-year - old man who visited samsung medical center reported experiencing palpitation for 2 weeks . 
 he had undergone excision of a mass in the right buttock due to rhabdomyosarcoma 7 years prior to this visit . 
 transesophageal echocardiography showed a pedunculated mass in the left ventricle , which was thought to be a vegetation of infective endocarditis , metastasis of the primary tumor , or thrombus . 
 he underwent removal of the cardiac tumor , and the pathologic report was metastatic rhabdomyosarcoma . 
 thus , here , we report a rare case of metastatic rhabdomyosarcoma in the left ventricle .