Identification of multiple cardiac metastases from nonsmall-cell lung cancer by 18F-FDG PET/CT

Abstract

Introduction:Multiple cardiac metastases from nonsmall-cell lung cancer are extremely rare. Multiple cardiac metastases detected by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) have not been previously reported.Patient concerns:A 53-year-old man was admitted to the hospital with left back pain for 1 month.Diagnoses:A contrast-enhanced computed tomography (CECT) scan showed a moderately enhancing mass with a necrotic area in the upper left lobe of the lung and a filling defect in the interventricular septum. Two-dimensional transthoracic echocardiography identified a mass attaching to the endocardial surface of interventricular septum. 18F-FDG PET/CT showed multiple intense 18F-FDG uptakes in the cardiac region. Nonsmall-cell lung cancer was confirmed by histopathologic examination of the mass in the upper left lobe of the lung.Intervention:The patient was treated with Gemcitabine chemotherapy.Outcomes:After 18 months of follow-up, the patient achieved stable disease status according to the Response Evaluation Criteria In Solid Tumors guidelines.Lessons:Our case demonstrates that 18F-FDG PET/CT is a sensitive and feasible imaging modality to diagnosis multiple cardiac metastases.

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

“…Echocardiography is generally the preferred initial cardiac imaging modality, allowing characterization of the site, size, and shape of cardiac tumors [9]. However, echocardiography is limited by a poor acoustic window in certain patients, no tissue characterization, and operator dependence [10]. Additionally, delineation of the endomyocardial border can be challenging [11], which limits the capacity of this modality to evaluate intracardiac tumors.…”

“…This modality, which highlights 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 [9]. 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 [10].…”