Tumors Metastatic to the Heart

Abstract

Downloaded from Goldberg et al Tumors Metastatic to the Heart 1791cardiac metastases in 2 recent large case series. 1,6 Tumor metastasis to the pericardium may initially result in pericarditis, with subsequent development of serosanguineous or hemorrhagic malignant pericardial effusions. 5,9,10 Depending on their size and rate of accumulation, malignant pericardial effusions may be symptomatic or silent. 5,9,10 Slow accumulation of pericardial effusions is unlikely to cause hemodynamic compromise, even with up to 2 L pericardial fluid. However, rapid accumulation of even small volumes from 100 to 200 mL can quickly result in cardiac tamponade, necessitating immediate pericardiocentesis to avert hemodynamic collapse. 9,10 Although echocardiography can identify the pericardial effusion, cardiac tamponade is a clinical diagnosis that relies on the presence of hypotension (often with a narrow pulse pressure), elevated jugular venous pressure, and distant heart sounds. 9,10 Although less common than pericardial effusions, deposits of pericardial metastases may also compromise cardiac output via constrictive pericarditis ( Figure 1C). However, this condition may also result from pericardial adhesions caused by radiation therapy or any prior surgery requiring sternotomy.Epicardial involvement (25%-34%) and myocardial involvement (29%-32%) represent the second and third most common sites of cardiac metastasis ( Figure 1D). 1,6 Depending on their location, epicardial or myocardial metastases may result in a variety of life-threatening complications. Disruption of the cardiac conduction system by cardiac metastases can lead to lethal arrhythmias, including atrial fibrillation with rapid ventricular response, complete atrioventricular block, or ventricular fibrillation. 1,5,11 Even in the absence of coronary artery involvement, metastases to the myocardium and pericardium can sometimes mimic acute coronary syndromes, presenting with chest pain, elevated cardiac biomarkers, and STand T-wave abnormalities compatible with symptomatic coronary artery disease.12 Cardiac output may also be directly compromised by replacement of the myocardium by tumor cells, resulting in congestive heart failure. 1,5 Rarely, deeply infiltrating myocardial metastases have even resulted in cardiac rupture, cardiac tamponade, and sudden death. 5Endocardial and intracavitary metastases are rare, making up 3% to 5% of cardiac metastases on autopsy. 1,6 However, such intracavitary metastases can have dramatic clinical consequences. Cardiogenic shock has been documented from right ventricular outflow tract obstruction ( Figure 1E). 13Cardiac metastasis can also cause symptomatic left ventricular outflow tract obstruction, a phenomenon usually observed in hypertrophic obstructive cardiomyopathy. Right heart failure may be seen from right atrial metastatic obstruction of right ventricular inflow. Cardioembolic complications of tumor emboli can include stroke from leftsided cardiac metastasis or pulmonary emboli from right-sided cardiac metastasis. In add...

A Patient with Lung Squamous Cell Carcinoma Presenting with Severe Cardiac Dysfunction Similar to Dilated Cardiomyopathy with Left Bundle Branch Block Induced by Myocardial Metastasis

“…Cardiac dysfunction, such as acute coronary syndrome, can also be observed if the myocardium is replaced by tumor cells (1). In this case, the autopsy examination did not show myocyte degeneration, interstitial fibrosis or direct replacement of the myocar- dium with tumor cells but revealed disruption of the cardiac conduction system due to myocardial metastasis.…”

“…Cardiac metastasis is found at autopsy in up to 10% of patients with known malignancies (1). Lung cancer is reported to be the most common malignancy that causes cardiac metastasis followed by breast cancer and hematologic malignancies (1)(2)(3)(4)(5)(6).…”

“…Lung cancer is reported to be the most common malignancy that causes cardiac metastasis followed by breast cancer and hematologic malignancies (1)(2)(3)(4)(5)(6). In some cases, cardiac metastases, specifically epicardial and myocardial metastases, may result in a variety of life-threatening complications including cardiac conduction system disruption such as complete atrioventricular (AV) block or ventricular fibrillation.…”

The Role of CMR Imaging for the Differential Diagnosis of Right-Sided Intracardiac Masses: A Case Report

“…The case signified the necessity of the rapid diagnose and timely treatment at such status. Nevertheless, the identification of the cardiac mass using the TTE or TEE for some groups of patients is complicated and the risk of misdiagnosis is higher due to the adjacent pathology that has already been diagnosed [8,10,11]. Several studies have shown that patients with recently diagnosed oncological process are at higher risk of the metastatic heart disease [11] and 15 % of the patients with any type of cancer may present with cardiac metastases [10].…”

Rare left ventricular metastasis from uveal melanoma

“…The evidence of a cardiac mass normally requires a complex differential diagnosis between benign tumors (myxoma, lipoma, papillary fibroelastoma, rhabdomyoma, fibroma, teratoma, Purkinje cells tumors/amarthomas, hemangioma), malignant tumors (angiosarcoma, rhabdomyosarcoma, fibrosarcoma, lymphosarcoma, osteosarcoma, liposarcoma), metastases, tumors that may be either benign or malignant (paraganglioma, mesothelioma) and non-neoplastic masses (intracardiac thrombus, endocarditis vegetation, lipomatous hypertrophy of interatrial septum, pericardial cyst, large coronary artery aneurism, crista terminalis) [6,7]. However, due to the clinical history and condition of the patient the possibility excluded was that the mass at the left side of the interventricular septum was a benign tumor.…”