Cardiac Comeback: CMR Detects Near-Complete Remission of Cardiac Metastases of Melanoma with Pembrolizumab

Presenting Author(s)

• EO

  Emma Obiri-Darko, BSc, MB

  Doctor
  Watford General Hospital, West Hertfordshire Hospitals NHS Trust
  London, England, United Kingdom

Primary Author(s)

• EO

  Emma Obiri-Darko, BSc, MB

  Doctor
  Watford General Hospital, West Hertfordshire Hospitals NHS Trust
  London, England, United Kingdom

Co-Author(s)

• RS

  Ritesh Sunnasy, BSc, MB

  Consultant Cardiologist
  Watford General Hospital, West Hertfordshire Hospitals NHS Trust
  Watford, England, United Kingdom

Description of Clinical Presentation: A 58-year-old female presented with an asymptomatic right breast lump, later identified as a metastatic melanoma of unknown primary. Cardiovascular magnetic resonance (CMR) performed to investigate pre-existing left ventricular impairment, revealed multiple intracardiac lesions consistent with metastases.

Diagnostic Techniques and Their Most Important Findings: Through cine, parametric mapping, and late gadolinium enhancement, CMR uniquely identified cardiac involvement of melanoma. Notably, this was not appreciated on other imaging modalities. After three cycles of pembrolizumab, repeat CMR demonstrated near-complete resolution of almost all intracardiac lesions. Importantly, the patient experienced no immune-related cardiac toxicities despite counselling about this risk.

Learning Points from this Case:

• CMR is highly sensitive for detecting and monitoring cardiac metastases.


• Immune checkpoint inhibitors, though associated with cardiotoxicity, may also induce near-complete remission of cardiac metastases, thereby improving prognosis.


• This case illustrates the therapeutic paradox of immunotherapy in the heart - both a potential hazard and a potential cure.

Learning Objectives
To highlight the unique role of CMR in detecting and monitoring cardiac metastases from melanoma. To demonstrate that pembrolizumab, despite its cardiotoxic potential, can induce near-complete cardiac remission. To emphasise the importance of balancing risks and benefits of immunotherapy in patients with cardiac involvement.

CMR Images of Cardiac Metastases Using Cine, Parametric Mapping and LGE
Interval CMR Showing Near-Complete Remission of Cardiac Metastases in Cine, Parametric Mapping and LGE