Objective: To identify cardiac metastases in a patient with a squamous cell carcinoma of the tongue and to clarify the relationship between cardiac metastases and sudden death. Study design: Autopsy and retrospective chart review for a patient. Methods: We studied a Japanese patient who Suddenly died after the operation and radiation therapy, despite an absence of thanatoid symptoms. We performed a subsequent autopsy. Results: The patient had four metastatic lesions in the heart, one of which was in the septum and infiltrated the region around the conducting system of the heart. Conclusion: Cardiac metastasis of tongue cancer may cause sudden death. (c) 2007 Elsevier Ireland Ltd. All rights reserved.