Report of a lung carcinoma extended to the left atrium through pulmonary vein

Abstract

Lung cancers may extend along or grow through the pulmonary veins to invade or lie within the left atrium (LA). A 62-year-old man, previously healthy, presented with 1-month ventilatory-independent right hemithorax back pain, dry cough and large effort dyspnea. He also referred weight loss of 12 kg in 10 months and denied hemoptysis. As antecedents, he smoked for 40 years and moderate daily alcoholism. On physical examination, the patient was in good general condition, hydrated and regular respiration at rest [blood pressure (BP) =120/80 mmHg; heart rate (HR) =90 bpm; respiratory rate (RR) =16 rpm]. Cardiac auscultation revealed two standard rhythmic sounds without murmurs. Pulmonary auscultation revealed a slightly diminished vesicular murmur in the lower 1/3 of the right hemithorax without adventitious noises. Chest radiography showed a mass over the right lower lung. A CT scan confirmed the radiography image with the mass extending along the right inferior pulmonary vein and a tumor in the LA. Transthoracic and transesophageal echocardiography revealed large mass within the LA (occupying almost the entire cavity), measuring about 10 cm × 3 cm at its largest diameter, prolapsing into the left ventricle. Bronchoscopy, head CT scan, and whole-body bone scintigraphy investigation did not show any distant metastasis. The patient was successfully operated removing the intracardiac and inferior pulmonary vein tumor with the aid of cardiopulmonary bypass, followed by a right inferior lobectomy carried out after 25 days. After 30 days from surgery presented seizures associated a brain metastasis evidenced by CT when adjuvant radio and chemotherapy was started. During the next 90 days, the clinical conditions worsened, and the patient died 4 months after the surgical treatment. The case report has two primary justifications, even considering the poor outcome: (I) rarity and (II) the possibility of the surgical treatment.

Invasion of poorly differentiated large‐cell neuroendocrine tumor of the lung through right pulmonary veins into the left atrium: A very rare case report

“…1 The right chambers of the heart are also most commonly involved by intracavitary metastasis but invasion of the left atrium (LA) through the venous routes is highly exceptional. 2 Neuroendocrine tumors are comprised of a heterogeneous group of malignancies, usually arising from the gastrointestinal (GI) tract and the bronchopulmonary system, but they can also develop in a wide variety of locations. These tumors account for 25% of primary lung neoplasms, with poorly differentiated large-cell neuroendocrine tumors comprising only 3% of all primary lung cancers.…”

Recurrent Stroke Due to Pulmonary Vein Thrombosis in a Patient with Metastatic Lung Adenocarcinoma

“…Pulmonary vein thrombosis (PVT) is a rare clinical entity. Etiologies can be classified into surgical-related and non-surgical-related etiologies [ 1 , 2 ]. Surgical-related PVT can occur as a complication following lung transplantation, lobectomy, and radiofrequency catheter ablation for atrial fibrillation [ 1 , 2 ].…”

“…Etiologies can be classified into surgical-related and non-surgical-related etiologies [ 1 , 2 ]. Surgical-related PVT can occur as a complication following lung transplantation, lobectomy, and radiofrequency catheter ablation for atrial fibrillation [ 1 , 2 ]. Non-surgical etiologies can be due to cardiac-related causes such as atrial myxoma, pulmonary venous narrowing, atrial fibrillation, or non-cardiac-related causes such as primary or secondary lung malignancies, polycythemia, and hemoglobinopathies such as sickle cell disease [ 1 – 6 ].…”

“…Non-surgical etiologies can be due to cardiac-related causes such as atrial myxoma, pulmonary venous narrowing, atrial fibrillation, or non-cardiac-related causes such as primary or secondary lung malignancies, polycythemia, and hemoglobinopathies such as sickle cell disease [ 1 – 6 ]. The pathogenesis of PVT is unclear, but previous studies have speculated that it could be due to turbulent flow or stasis in the pulmonary vein (PV) stump after lobectomy [ 2 ]. Malignancy-related etiologies are thought to be due to direct extension of the tumor into the vein, compression of the vein by the tumor, epithelial damage as a result of tumor invasion, or due to a hypercoagulable state [ 2 ].…”

“…The pathogenesis of PVT is unclear, but previous studies have speculated that it could be due to turbulent flow or stasis in the pulmonary vein (PV) stump after lobectomy [ 2 ]. Malignancy-related etiologies are thought to be due to direct extension of the tumor into the vein, compression of the vein by the tumor, epithelial damage as a result of tumor invasion, or due to a hypercoagulable state [ 2 ]. Patients with PVT are usually asymptomatic but may present with nonspecific symptoms such as dyspnea, cough, or hemoptysis [ 3 , 6 ].…”