Metastatic adenocarcinoma involving the right ventricle and pulmonary artery leading to right heart failure: case report

Abstract

CONTEXT: Obstruction of the right ventricular outflow tract due to metastatic disease is rare. Clinical recognition of cardiac metastatic tumors is rare and continues to present a diagnostic and therapeutic challenge. CASE REPORT: We present the case of a patient who had severe respiratory insufficiency and whose clinical examinations revealed a giant tumor mass extending from the right ventricle to the pulmonary artery. We discuss the diagnostic and therapeutic options. CONCLUSION: In patients presenting with acute right heart failure, right ventricular masses should be kept in mind. Transthoracic echocardiography appears to be the most easily available, noninvasive, costeffective and useful technique in making the differential diagnosis. RESUMO CONTEXTO:A obstrução da via de saída do ventrículo direito devido a doença metastática é rara. O reconhecimento clínico de tumores cardíacos metastáticos é raro e continua a apresentar um desafio diagnóstico e terapêutico. RELATO DO CASO: Apresentamos o caso de um paciente com insuficiência respiratória grave e cujos exames clínicos revelaram massa de tumor gigante, estendendo-se desde o ventrículo direito até a artéria pulmonar. Discutimos as opções diagnósticas e terapêuticas. CONCLUSÃO: Em pacientes com insuficiência cardíaca direita aguda, massas do ventrículo direito devem ser mantidas em mente. Ecocardiografia transtorácica parece ser a técnica mais facilmente disponível, não invasiva, custo-efetiva e útil no diagnóstico diferencial. I MD. Associate Professor,

A Patient with a Massive Single Cardiac Metastasis of Lung Adenocarcinoma, Diagnosed via a Biopsy

“…Right ventricular metastasis of hepatocellular carcinoma has been previously reported ( 4 ). However, only a few cases of endocardial metastases of lung adenocarcinoma have been reported ( 5 ).…”

Obstructive Cardiac Tumors

“…These cases manifest with signs and symptoms of right heart failure, such as ascites, jugular swelling, lower limb edema, cyanosis, syncope, right bundle branch block, systolic ejection murmur along left sternal border, pulmonary hypertension, and even sudden death. Cases of pulmonary embolism secondary to tumor fragmentation and displacement [23][24][25] have already been described. Neuroendocrine tumors can be more associated with heart failure due to valve involvement, as occurs in carcinoid syndrome.…”

“…26 There are numerous case reports of metastases causing ventricular outflow tract obstruction related to neoplasms of several primary sites, such as soft tissue sarcoma, lymphoma, leukemia, liposarcoma, ovary carcinoma, renal cell adenocarcinoma, hepatic tumors, pancreatic and colorectal adenocarcinoma, and even squamous cell carcinoma of the base of the mouth. 24,25,[27][28][29][30] Although less common, there are reports of left ventricular inflow (Figure 5) and outflow obstruction in individuals with synovial sarcoma of the foot and grade III pleomorphic leiomyosarcoma, both undergoing treatment with chemotherapy and radiation therapy and evolving to death after 3 and 6 months. 27 The main manifestation of left ventricular obstruction is progressive dyspnea.…”

“…Treatment strategies such as placement of prostheses (stents) on the right ventricular outflow tract in a patient with metastatic sarcomatoid carcinoma and emergency surgery with or without pulmonary and/or tricuspid valve repair followed by neoadjuvant chemotherapy have already been described. [23][24][25] In many cases, cardiac metastases are found in already disseminated tumors, in which palliative treatment with…”