Intracardiac and Transesophageal Echocardiography–Guided Biopsy of a Large Epicardial Mass

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BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine malignancy with high metastatic potential. Cardiac involvement is rare and usually occurs late in the disease course. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: A 76-year-old man with recurrent MCC was found to have a large epicardial mass encasing the right coronary artery. Surgical and external percutaneous biopsy approaches were considered high risk. DISCUSSION: A transcatheter biopsy was performed using multimodality imaging. Intracardiac echocardiography enabled real-time visualization, while transesophageal echocardiography provided higher resolution to confirm accurate forceps positioning. Diagnostic tissue was successfully obtained, confirming recurrent MCC and informing subsequent oncologic therapy. NOVELTY: This appears to be the first description of transcatheter biopsy of an epicardial mass guided by both intracardiac and transesophageal echocardiography. TAKE-HOME MESSAGES: Multimodality imaging can facilitate safe biopsy of select cardiac masses. Tissue confirmation remains important when management decisions depend on histology.

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