No abstract

Secondary tumours of the heart are not uncommon. Hudson (1965) gives a full bibliography. The degree and site of involvement, however, are variable. They may occur in widely disseminated neoplasms such as melanomas and lymphoblastomas, or be the result of tumours with a tendency to grow along veins. The latter may extend into the atrium; this appears to be less rare on the right than on the left side of the heart. Willis (1953) quoted Herzog (1917) who described a teratoma of testis which passed through the inferior vena cava to the right atrium and ventricle, and he himself reports that some cases of renal carcinoma and of chondrosarcoma have been described, extending through the inferior vena cava into the right side of the heart and even into the pulmonary arteries. Willis noted, however, that the pulmonary veins were invaded by tumour only rarely. In view of the rarity of invasion of the pulmonary vein by tumour tissue the surprising findings at necropsy in our case prompted us to make this brief report, particularly since in retrospect they probably explain the sudden onset of heart failure not understood by us at the time of its occurrence. Case ReportA 38-year-old man was admitted to Stobhill Hospital, Glasgow, on April 21, 1965 with polyarthritis. For some four months he had had recurring pain in the right shoulder and elbow joints and both ankle joints.Over this period he had experienced frequent severe sweats. There had been no significant change in weight. He had a cough which he attributed to a heavy cigarette consumption of up to 40 a day, but he had not noticed anything unusual about the character of sputum.There was striking finger-clubbing and some thickening of the right wrist. There was wasting of the right deltoid muscle. Clinical signs of consolidation were noted in the right upper lobe. The chest x-ray film was unusual; it showed two large homogeneous opacities in the upper'part of the right lung field (Fig. 1). The lateral view showed that one of them was in the apical segment and the other in the anterior segment of the right upper lobe. The right lobe of the diaphragm was raised.The diagnosis was made of intrapulmonary tumour of doubtful aetiology, pulmonary osteoarthropathy, and ? carcinomatous neuropathy. He was anemic (Hb-8-9 g./100 ml.). His sedimentation rate was 133 mm. in one hour, and his temperature was raised. His main complaint in the first few days after admission was of pain in the shoulder and wrist joints. The chest x-ray appearances prompted a search for a primary focus outside the lungs but none was found in breast, thyroid, kidneys, or alimentary tract. Bronchoscopy was not carried out, because the surgeon, like ourselves, was of the opinion that the lung involvement was almost certainly secondary, and because the patient was extremely distressed and dyspnoeic when seen by him four days after admission. He had become dramatically more dyspnaeic in these four days, and signs of rightsided heart failure had developed. This we were unable to explain on clinical grounds. H...

No abstract

No abstract

One of us (Rogen, 1957) has reported a patient in whom extensive cardiographic abnormalities were associated with massive urticaria, the abnormalities being of short duration and clearing with rapid recovery from the urticaria. Her condition is summarized shortly as Case 2. The first patient reported here as Case 1 had associated mild urticaria only, but the electrocardiogram showed features similar to those previously reported by others. We have been given notes about another patient (Case 3), similar except that the cardiographic changes lasted for longer. Case 1. A young man, aged twenty-one, had been ill since he had eaten a sandwich made with tinned pilchards. Six hours after eating the sandwich he developed severe generalized abdominal pain, which lasted until the following morning: there was occasional vomiting and diarrhoea in the form of two to three loose, normally coloured, stools in the day for the five days until he was admitted to hospital. Shortly after the onset of the abdominal pain he felt "a gripping pain" in the left mammary region radiating down the inner aspect of both arms to the elbows, the pain lasting about ten minutes at a time and recurring roughly every three hours. This type of pain was troublesome for the first three days of his illness, but for the two days before his admission it alternated with two attacks of severe bilateral constricting chest pain lasting up to 13 hours. With the second attack of severe long-lasting pain he felt dizzy and weak and sweated. It was shortly after the cessation of this attack of pain that he was admitted to Ruchill Hospital. He gave no history of recent cold, sore throat, or joint pains.He was a well-built young man who indulged in boxing and swimming without chest pain or other ill effects. There was no history of recent injections or of drug taking and no history of any skin rash following the taking of medicines in the past. One sister, aged 17, had psoriasis but there was no history of allergic disease in the patient, his parents, or his two sisters. The patient had no diarrhoea or chest pain while in hospital. He was not dehydrated. He had a mild urticarial eruption on the back of his chest which cleared within three days. There was no triple rhythm or other significant abnormality on clinical examination of the heart. His blood pressure was labile and was most commonly around 120/70 mm. Hg. Two specimens of stool were negative for intestinal pathogenic organisms. Haemoglobin, white blood count, and differential white blood count were within normal limits, and no abnormality was found in the urine or on radiological examination of heart or lungs.A cardiogram taken on admission showed changes compatible with antero-lateral ischiemic heart damage ( Fig. 1): that taken three days later was normal (Fig. 2). No drug treatment was given.The only evidence of an allergic reaction in this patient was the fine urticarial eruption noted on his back; this cleared rapidly after his admission to hospital and was absent when the second cardiogram was taken...