Metastatic right ventricular mass with intracavitary obliteration

Abstract

Metastatic cardiac tumors are more common than the primary cardiac tumors. Cervical cancer metastasizing outside of the pelvis is commonly spread to the lungs, liver, bones and lymph nodes than to the heart. Right-sided metastasis to the heart is more common than to the left side. Intramural spread is more common than intracavitary growth of metastatic cardiac tumors leading to delayed clinical presentation. Intracavitary mass can be confused with intracavitary thrombus which can be seen in the setting of pulmonary embolism. Transthoracic echocardiography plays a major role in the decision making and management of pulmonary embolism, and this modality can also be used to diagnose cardiac masses. Other modalities like TEE, cardiac CT, cardiac MRI and PET-CT scan have further utility in delineating these masses. This may help to plan appropriate management of the right ventricular mass particularly in cases where the patient history and CT pulmonary angiography results favor the diagnosis of pulmonary embolism. We present the case of a 49-year-old woman with a history of supracervical hysterectomy and salpingo-oophorectomy on oral estrogen therapy who was admitted with complaints of pleuritic chest pain and respiratory insufficiency after a long flight. Initial work-up showed sub-segmental pulmonary embolus in the right posterior lower lobe pulmonary artery, and the patient was managed on intravenous heparin. Lack of appropriate response to standard therapy led to further evaluation. Multimodality imaging and biopsies revealed a large right intracavitary ventricular metastatic squamous cell tumor, with the cervix as the primary source.

What lies beneath: A case of cardiac metastases presenting as pulmonary embolism.

“…Cardiac tumors can cause thromboembolism by 2 mechanisms: thrombus formation overlying the tumor surface and tumor fragmentation. 7,9,10 Our case is unique in 2 aspects: 1) metastasis to the heart occurred in the absence of overt other metastases in a patient with cutaneous SCC which has a very low potential for cardiac metastasis and thromboembolism; 2) cardiac metastases was associated with mural thrombus and pulmonary embolism which created a diagnostic difficulty and delay. Our case highlights the importance of suspecting metastatic spread to the heart in such patients with history of malignancy who present with pulmonary embolism and RV abnormalities.…”

“…4,5 In other cases, cMRI and/or PET imaging helped disclose underlying malignancy. 6,7 While some primary malignancies such as gastric, lung, pancreatic and brain and certain histologic types such as adenocarcinomas carry a high risk for thromboembolism, rates of thromboembolism with cutaneous SCC is low. In one analysis of a large national cohort, the risk of thromboembolism in patients with cSCC was similar to general population.…”

Identification of multiple cardiac metastases from nonsmall-cell lung cancer by 18F-FDG PET/CT

“…Some studies have demonstrated that cardiac MRI can provide better detection and tissue characterization in the assessment of cardiac metastasis. [10,11] However, cardiac MRI remains less available than CT or echocardiography. The major limitation of MRI is the contraindication in patients with intracardiac defibrillators or pacemakers.…”

Diagnosis and treatment of right ventricular metastasis from esophageal squamous cell carcinoma: An unusual case report and a literature review

“…Osati E et al [20] 2017 1 21/M RV osteosarcoma 5.99 × 5.59 Chemothearapy Unknown Kalvakuri K et al [21] 2016 1 49/F RV CSCC 8 × 4 × 2.5 Surgery 0.2/Death Hajsadeghi S et al [22] 2020 1 60/F RV and RA UCA 7.5X4X3 Surgery 0.008/ Death Zakhartseva LM et al [23] 2018 1 24/M RV Testicular tumor Unknown Surgery Unknown Kawakami J et al [24] 2022 1 71/F Right interatrial septum Liposarcoma Unknown Provision of palliative care…”