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An unusual case of metastasis to the left side of the heart: a case report.

Cheruvu B, Cheruvu P, Boyars M - J Med Case Rep (2011)

Bottom Line: The most common neoplasms that metastasize to the heart are malignant melanoma, lymphoma, and leukemia, but the relative numbers are greater with breast and lung cancers, reflecting the most common incidence of these cancers.A 60-year-old Hispanic man presented to our hospital after being transferred from an outside hospital for workup and evaluation of an adrenal mass of the abdomen and pelvis, found on computed tomography.Cancers which have metastasized to the heart are found in six to 20% of patients with malignant neoplasms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, University of Texas, 301 University Boulevard, Galveston, TX 77555, USA. kiriti121@sbcglobal.net.

ABSTRACT

Introduction: Cardiac metastases are found in six to 20% of autopsies of patients with malignant neoplasm. The most common neoplasms that metastasize to the heart are malignant melanoma, lymphoma, and leukemia, but the relative numbers are greater with breast and lung cancers, reflecting the most common incidence of these cancers.

Case presentation: A 60-year-old Hispanic man presented to our hospital after being transferred from an outside hospital for workup and evaluation of an adrenal mass of the abdomen and pelvis, found on computed tomography. His chief complaint upon admission was altered mental status. Physical examination was unremarkable. He was alert and oriented and had a dry and non-erythematous oropharynx, and bilateral diffuse wheezing on lung examination. Computed tomography of the chest showed multiple hypodense lesions in the left ventricular myocardium, suggestive of metastases. There were also tiny sub-centimeter nodular densities in the right upper and lower lobes. Adrenal glands contained hypodense lesions, which showed characteristic adenocarcinomatous malignant cells.

Conclusion: Cancers which have metastasized to the heart are found in six to 20% of patients with malignant neoplasms. The right side of the heart is more commonly involved in metastasis. This study is unusual in that a tumor of an unknown primary origin had metastasized to the left side of the heart.

No MeSH data available.


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CT guided aspiration of bilateral adrenals showing metastatic adenocarcinoma.
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Figure 1: CT guided aspiration of bilateral adrenals showing metastatic adenocarcinoma.

Mentions: Our patient was slightly anemic with hemoglobin level of 11.9 with no leukocytosis. All electrolytes were within normal limits. A repeat CT scan was performed. CT of the chest showed mild calcified pleural thickening at the right apex. Tiny sub-centimeter nodular densities were detected in the right upper and lower lobes. The left ventricular myocardium contained multiple hypodense lesions which bore close resemblance to metastases. A centrally hypodense (likely necrotic), enlarged (size 2 cm) sub-carinal lymph node was also seen. The liver, spleen, pancreas, and kidneys appeared normal. Bilaterally, the adrenal glands contained large hypodense lesions measuring 2.6 × 2.3 cm on the right and 4.1 × 3 cm on the left. No intestinal wall thickening or evidence of intestinal mass was identified. Small, centrally hypodense nodular foci were seen in the abdomen and pelvis. Two were located in the peritoneum near the tip of the liver, and another was seen adjacent to the left acetabulum along the iliac chain. The latter bore close resemblance to a necrotic lymph node. Innumerable metastatic foci were seen throughout the posterior paraspinal musculature, iliopsoas muscles and gluteus muscles. A 1.2 cm metastatic lesion was seen in the left iliacus muscle superiorly and appeared to violate the anterior aspect of the left iliac wing. Sacrococcygeal metastatic lesion was also seen. A biopsy of the adrenal lesions performed under CT-guided aspiration showed characteristics of metastatic adenocarcinomatous malignant cells (Figures 1 and 2).


An unusual case of metastasis to the left side of the heart: a case report.

Cheruvu B, Cheruvu P, Boyars M - J Med Case Rep (2011)

CT guided aspiration of bilateral adrenals showing metastatic adenocarcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037322&req=5

Figure 1: CT guided aspiration of bilateral adrenals showing metastatic adenocarcinoma.
Mentions: Our patient was slightly anemic with hemoglobin level of 11.9 with no leukocytosis. All electrolytes were within normal limits. A repeat CT scan was performed. CT of the chest showed mild calcified pleural thickening at the right apex. Tiny sub-centimeter nodular densities were detected in the right upper and lower lobes. The left ventricular myocardium contained multiple hypodense lesions which bore close resemblance to metastases. A centrally hypodense (likely necrotic), enlarged (size 2 cm) sub-carinal lymph node was also seen. The liver, spleen, pancreas, and kidneys appeared normal. Bilaterally, the adrenal glands contained large hypodense lesions measuring 2.6 × 2.3 cm on the right and 4.1 × 3 cm on the left. No intestinal wall thickening or evidence of intestinal mass was identified. Small, centrally hypodense nodular foci were seen in the abdomen and pelvis. Two were located in the peritoneum near the tip of the liver, and another was seen adjacent to the left acetabulum along the iliac chain. The latter bore close resemblance to a necrotic lymph node. Innumerable metastatic foci were seen throughout the posterior paraspinal musculature, iliopsoas muscles and gluteus muscles. A 1.2 cm metastatic lesion was seen in the left iliacus muscle superiorly and appeared to violate the anterior aspect of the left iliac wing. Sacrococcygeal metastatic lesion was also seen. A biopsy of the adrenal lesions performed under CT-guided aspiration showed characteristics of metastatic adenocarcinomatous malignant cells (Figures 1 and 2).

Bottom Line: The most common neoplasms that metastasize to the heart are malignant melanoma, lymphoma, and leukemia, but the relative numbers are greater with breast and lung cancers, reflecting the most common incidence of these cancers.A 60-year-old Hispanic man presented to our hospital after being transferred from an outside hospital for workup and evaluation of an adrenal mass of the abdomen and pelvis, found on computed tomography.Cancers which have metastasized to the heart are found in six to 20% of patients with malignant neoplasms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, University of Texas, 301 University Boulevard, Galveston, TX 77555, USA. kiriti121@sbcglobal.net.

ABSTRACT

Introduction: Cardiac metastases are found in six to 20% of autopsies of patients with malignant neoplasm. The most common neoplasms that metastasize to the heart are malignant melanoma, lymphoma, and leukemia, but the relative numbers are greater with breast and lung cancers, reflecting the most common incidence of these cancers.

Case presentation: A 60-year-old Hispanic man presented to our hospital after being transferred from an outside hospital for workup and evaluation of an adrenal mass of the abdomen and pelvis, found on computed tomography. His chief complaint upon admission was altered mental status. Physical examination was unremarkable. He was alert and oriented and had a dry and non-erythematous oropharynx, and bilateral diffuse wheezing on lung examination. Computed tomography of the chest showed multiple hypodense lesions in the left ventricular myocardium, suggestive of metastases. There were also tiny sub-centimeter nodular densities in the right upper and lower lobes. Adrenal glands contained hypodense lesions, which showed characteristic adenocarcinomatous malignant cells.

Conclusion: Cancers which have metastasized to the heart are found in six to 20% of patients with malignant neoplasms. The right side of the heart is more commonly involved in metastasis. This study is unusual in that a tumor of an unknown primary origin had metastasized to the left side of the heart.

No MeSH data available.


Related in: MedlinePlus