e22017 Background: Melanomas are highly aggressive tumors that can metastasize to a wide array of organs, including the heart. Cardiac metastasis is rare and most often diagnosed post-mortem. Here, we perform a systematic review evaluating patient demographics, characteristics, management, and outcomes of cardiac melanoma metastases. Methods: A comprehensive literature review was performed in Cochrane Library, PubMed, and EmBase databases. Study quality was determined based on study design and clinical endpoints using the Oxford Center for Evidence Based Medicine (OCEBM) Levels of Evidence categorization. Demographic data, patient symptomatology, imaging findings, management strategies, and patient outcomes were collected and analyzed. Results: Thirty studies, all case reports or case series, met inclusion criteria. In total, 33 patients with cardiac metastasis from melanoma were identified and histologically confirmed. All 30 studies included in this review received an evidence level of 4 based on OCEBM Levels of Evidence categorization. The most common presenting symptom at the time of diagnosis of cardiac metastasis was shortness of breath (36.4%) and the most common physical exam finding was tachycardia (24.2%). The most common site of cardiac metastasis was the left ventricle (41.9%), followed by the right atrium (35.5%). Notable echocardiogram findings included right ventricular inflow obstruction (27.6%) and valvular dysfunction (24.1%). Valvular dysfunction, classified as prolapse, regurgitation, or stenosis, always involved the tricuspid valve. Treatment strategies typically involved surgical intervention (66.7%), chemotherapy (39.4%), or chemotherapy with surgical intervention (15.2%). Of the 22 cases that reported outcomes, the majority (59.1%) were disease-free without evidence of recurrence. Two patients (9.1%) experienced recurrence within one year of treatment and eight patients (36.4%) expired within 12 months. Conclusions: When symptomatic, cardiac melanoma metastases typically present with shortness of breath and tachycardia, with a predilection for the left ventricle and right atrium. Surgical intervention is currently the mainstay of treatment for successful cardiac melanoma metastasis management. [Table: see text]
Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective treatment with no adverse outcomes or sequelae.
Although pericardial lipomas are both rare and benign, rapid or excessive growth can induce potentially fatal conditions such as pericarditis, arrhythmia, and cardiac tamponade. This case illustrates an example where a 65-year-old with atypical chest tightness unveiled a 10×15 cm anterior pericardial mass with circumferential effusion and progressive deterioration to cardiac tamponade. Initial transthoracic echocardiogram imaging was technically difficult in this patient due to habitus and body mass, which failed to illustrate underlying effusion. Recurrent bouts of refractory supraventricular tachycardia prompted further investigation of this patient’s presentation with transesophageal echocardiogram, which showed evidence of an echogenic mass with cardiac tamponade. An urgent pericardial window and pericardial lipectomy immediately relieved this hemodynamically compromising condition. Subsequent atrial flutter resulted with the removal of the anterior fat pad during surgery, complicating recovery.
Background Cardiac metastasis of melanoma is rare and typically diagnosed post‐mortem. Here we perform a retrospective cohort study and systematic review of patients with metastatic melanoma to characterize prevalence, clinical characteristics, and outcomes of cardiac metastasis. Methods We reviewed the electronic medical records of all outpatients with metastatic melanoma who underwent evaluation at the University of Michigan in Ann Arbor from January 2009 to January 2022, identifying patients with a clinical or histopathologic diagnosis of cardiac metastasis. We performed a systematic review of the literature to summarize the clinical characteristics and outcomes of patients with melanoma and cardiac metastasis. Results Overall, 23 of 1254 (1.8%) patients with metastatic melanoma were diagnosed with cardiac metastasis. Cardiac metastasis was reported in the right ventricle (65%), left ventricle (35%), and right atrium (35%). A total of 11 (48%) patients experienced at least one cardiovascular complication after the diagnosis of cardiac metastasis, the most common being arrhythmia (30%), heart failure (22%), and pericardial effusion (17%). Immunotherapy was more commonly used in patients with cardiac metastasis (80% vs 65%; p = 0.005). Mortality at 2‐years post‐diagnosis was higher for patients with cardiac metastasis compared to those without (59% vs 37%; p = 0.034). Progression of malignancy was the underlying cause of death of all patients. Conclusions Cardiac metastasis occurs in <2% of patients with metastatic melanoma, can affect all cardiac structures, and is associated with various cardiovascular complications and high mortality.
Central retinal vein occlusion (CRVO) typically manifests as unilateral vision loss from thrombosis and occlusion of the central retinal vein in patients with thrombophilic risk factors. Here we report a case of a 23-year-old male with three weeks of intermittent left-sided eye pressure and vision loss, who was found to have decreased visual acuity, retinal hemorrhages, and an impending CRVO in his left eye. Upon further evaluation, infectious disease and autoimmune labs were normal, but he had mildly increased right heart pressures and hypercoagulable changes in the right middle cerebral artery. He denied any personal or family history of clotting disorders but noted a four-year history of vaping. He was started on anticoagulation and discharged. Outpatient genetic testing for Factor V Leiden, protein C, protein S, and prothrombin G20210 was normal. His visual acuity returned to normal in the left eye and the retinal hemorrhages resolved. After the exclusion of organic causes, significant vaping history was considered the likely etiology of his hypercoagulable state and resultant CRVO. Vaping-related clotting phenomena may explain the etiology of an otherwise unexplained CRVO, but further investigation of the long-term health consequences of electronic cigarette use is still needed.
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