A Multimodal Approach to Evaluate for Cardiac Metastasis in a Case of Non-Small Cell Lung Cancer

Abstract

Malignancies have demonstrated the ability to metastasize to cardiac tissue. However, an optimal diagnostic algorithm for cardiac tumors has not yet been established, due at least in part to the scarcity of symptomatic cases. Several case reports describe how the usage of 18 F-labeled fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) incidentally revealed cardiac neoplasia. This modality, which indicates uptake sites of the radioisotope 18 F-FDG, allows for whole-body imaging and is often used for preoperative determination of malignant metastasis or for assessing response to therapy over time. However, findings of false positivity are often reported due to increased FDG avidity caused by a range of other, nonmetastatic processes, most notably inflammation and infection. In this case report, an 84-year-old male with stage IV non-small cell lung cancer presented a clinical course, echocardiogram, and 18 F-FDG PET-CT findings that were suggestive of endocardial metastasis. Nine months into therapy, after extensive consultation, the patient finally consented to a more complete workup using cardiac MRI (CMRI), which showed no evidence of cardiac metastasis. This case report supports the utility of CMRI as a means of further interpreting intracardiac, localized FDG uptake foci in PET-CT findings, in order to avoid false positivity and further refine proposed cardiac differential diagnoses in cancer patients.

Endocavitary Right Ventricular Cardiac Metastasis of a Lung Adenocarcinoma Treated by Surgery: A Case Report About a Novel Multimodal Therapeutic Approach

“…They can reduce the specificity, making it crucial to consider the clinical context. Bilani et al [11] reported a case of a false positive cardiac uptake, later confirmed by CMR. They also highlighted the challenge of pseudoprogression under immunotherapy, which can often manifest in the early months of treatment and, in some cases, even later.…”

Cancer and Matters of The Heart: Cardiac Metastases and The Potential Presentation to the Emergency Department

“…The more experienced the person performing the echocardiographic studies, the higher the likelihood of picking up even smaller abnormalities. It is also important to note that often the test is being done for other reasons but incidentally picks up the suspected cardiac metastases [19,[20][21][22]. Other investigations such as Cardiac Ultrasound (CUS), CT Scan and magnetic resonance imaging (MRI) are also useful for further definition and confirmation.…”

“…MRI also gives better definition of the surrounding structures, which is crucial in the assessment of spread. PET (Positron emission tomography) scans are at times used because it is part of the armamentarium of tests for working up the primary cancer, such as head and neck cancers [20,21]. Chest Xrays are usually non-specific and may show cardiomegaly and at times, prominence of the azygous vein if pericardial effusion is present.…”