Neoplastic Pericardial Effusion Induces Functional Nonvalvular Mitral Valve Stenosis

Abstract

W e describe a 53-year-old man with primary diagnosis of non-small-cell lung cancer admitted to the hospital with progressive dyspnea. Transthoracic echocardiography revealed a nonechodense pericardial mass (PM) (Online Video 1) and secondary obstruction of the mitral orifice. Cardiac magnetic resonance imaging showed an inhomogeneous mass lateral of the left atrium (LA) and left ventricle (LV) (Online Video 2) causing a mitral valve (MV) stenosis (A and B). No contrast uptake of the mass could be seen on firstpass cardiac magnetic resonance perfusion (C), but diffuse and sparse contrast uptake by late gadolinium enhancement (D). A mean pressure gradient of 7 mm Hg and a maximal pressure gradient (PG) of 16 mm Hg (E) were found by echocardiography. The valvular opening was restricted to 1.2 cm 2 as assessed planimetrically by cardiac magnetic resonance imaging (F). Histology of the effusion showed large atypical cells with prominent nuclei and an increased nucleus-cytoplasm-ratio adequate to a pleural manifestation of the carcinoma (G). MPG ϭ mean pressure gradient; RA ϭ right atrium; RV ϭ right ventricle; VTI ϭ velocity time integral.