American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell Lung Cancer

Apical 4-chamber view of the cardiac metastasis in the right ventricle.

Cardiac tumors have generally been considered to be rare. They are often found incidentally, as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac tumors.1 Although melanoma and pleural mesothelioma often have cardiac involvement, the most common cancers to be identified in cardiac metastases are lung cancer (36%-39%), breast cancer (10%-12%), and hematologic cancers (10%-21%).2

Case

A 56-year-old man with a past medical history of methamphetamine and tobacco abuse presented to the emergency department with 3 weeks of dyspnea, cough, and fevers. Initial vital signs were significant for tachycardia and tachypnea. On physical examination, he had egophony in the left lower lung base and bilateral lower extremity edema. Laboratory results were significant for a white blood cell count of 21.4 k cells/µL, hemoglobin of 6.2 g/dL, and 450 k platelets/µL. Chest x-ray showed a left lower lobe opacity with a small pleural effusion. Computed tomography of the chest, abdomen, and pelvis with contrast showed a 7.5-cm left lower lobe lung mass, a 5.3-cm intraventricular septal/apical mass concerning for metastasis, and a lytic lesion of the right humeral neck. Echocardiogram confirmed a right ventricle apical mass (4.3 × 3.0 cm) with septal flattening consistent with right ventricular pressure and volume overload (Figure). A biopsy of the right humeral lytic lesion showed metastatic poorly differentiated non–small cell lung cancer, most consistent with squamous cell carcinoma. He was given a round of chemotherapy with carboplatin and taxol. After ongoing discussions with the patient, he was discharged to hospice for palliative services.

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-Carmel Moazez, MD, Emily Howard, DO, Azar Mehdizadeh, MD, Raina Roy, MD, Surabhi Amar, MD

This article originally appeared in the December issue of The American Journal of Medicine.

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