Author + information
- Received October 21, 2015
- Revision received November 9, 2015
- Accepted November 19, 2015
- Published online February 8, 2016.
- Dieter Dauwe, MD, PhDa,
- Nick Hiltrop, MDa,∗ (, )
- Willem Schurmans, MDa,
- Philippe Moerman, MD, PhDb,
- Jan Bogaert, MD, PhDc,
- Stefan Janssens, MD, PhDa and
- Mark Coosemans, MDa
- aDepartment of Cardiovascular Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- bDepartment of Histopathology, Translational Cell and Tissue Research, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- cDepartment of Radiology, Translational MRI, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- ↵∗Reprint requests and correspondence:
Dr. Nick Hiltrop, Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
A 49-year-old male was admitted for surgical resection of a solitary pulmonary metastasis. A mixed germ cell testis tumor (mature teratoma and seminoma) was diagnosed 1 year before and treated with orchidectomy and adjuvant chemotherapy. Surgical resection of regional retroperitoneal disease progression during follow-up demonstrated transformation into high-grade sarcoma. Four days after lung surgery, he experienced chest pain. An electrocardiogram showed anteroseptal ST-segment elevation. Transthoracic echocardiography confirmed anteroseptal hypocontractility and revealed a large mobile left ventricular mass (Figure 1C, Online Video 1). Urgent coronary angiography demonstrated an occluded proximal left anterior descending coronary artery (Figure 1A). Evacuation of solid tissue during thrombus aspiration restored coronary perfusion with symptom relief and ST-segment normalization (Figure 1B). Histopathology of the thrombus identified a high-grade sarcoma ex teratoma, suggesting embolization from an intracardiac metastasis (Figures 1D to 1G). The patient deceased shortly after due to therapy-resistant cerebral edema and intracranial compression attributable to 2 new brain metastases.
Reported incidences of cardiac metastases are variable, ranging from 2.3% to 18.3% in patients dying from or with cancer (1). Cardiac or pericardial metastases should be considered whenever patients with known malignancy develop cardiovascular symptoms. Myocardial infarction is a rare but known complication of cardiac metastases.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 21, 2015.
- Revision received November 9, 2015.
- Accepted November 19, 2015.
- American College of Cardiology Foundation