Gestational Trophoblastic Neoplasia With Intracardiac Metastatic Masses

BACKGROUND: Gestational trophoblastic neoplasia (GTN) with cardiac involvement is exceedingly rare and may mimic thrombus or primary cardiac tumor, complicating diagnosis. CASE SUMMARY: A 28-year-old woman with a history of complete hydatidiform mole presented with acute cardiopulmonary symptoms, abdominal pain, and markedly elevated β-human chorionic gonadotropin (β-hCG) levels. Multimodality imaging revealed mobile left-sided intracardiac masses with pulmonary vein extension and metastatic renal lesions. Stage IV high-risk GTN was diagnosed without tissue biopsy, and multiagent chemotherapy was initiated, resulting in sustained β-hCG normalization and near-complete resolution of intracardiac masses on follow-up imaging. DISCUSSION: This case highlights the diagnostic challenges of cardiac involvement in GTN and underscores the importance of multimodality imaging in differentiating metastases from thrombus, enabling prompt initiation of life-saving systemic therapy. TAKE-HOME MESSAGES: GTN should be considered in patients with markedly elevated β-hCG and unexplained intracardiac masses. Multimodality imaging is essential to guide timely and appropriate diagnosis and management.