Preoperative identification and operative management of intraatrial extension of lung tumors

Echocardiographic detection of left atrium and left ventricle tumoral invasion via the left upper pulmonary vein, leading to the diagnosis of lung cancer

Left atrial (LA) invasion by lung cancer via hematogenous pathways is relatively uncommon. Herein we report the case of a 68-year-old male without any medical history, in whom lung cancer was diagnosed by transesophageal echocardiographic detection of the LA and left ventricle tumoral invasion via the left upper pulmonary vein. The primary source of tumor was found out by computed tomography.

Stage IIIa cancer of the right lung ingrowing via right lower pulmonary vein to the left heart atrium

Computed tomography is performed in every patient before lung tumour resection. The presented case realises how important it is to perform this study with contrast. In a 75-year-old male we detected a tumour ingrowing from the right lung through the right lower pulmonary vein into the left atrium of the heart. The patient was qualified for primary sternotomy with extracorporeal circulation and resection of the intracardiac part of the tumour. In the second stage, right-sided thoracotomy was performed, and right lower lung lobectomy was done. Mixed heterogeneous lung cancer was diagnosed (squamous cell and non-small cell endocrine) in stage IIIa. The perioperative period was uncomplicated. The patient, due to renal failure, was not eligible for adjuvant chemotherapy. If the patient were qualified for lobectomy based directly on computed tomography without contrast, there would have been a high risk of perioperative death due to embolic incidents and heart failure. Effective multidisciplinary collaboration allowed us to avoid this sort of complication.

Metastatic meningioma extending into the left atrium through the pulmonary vein

Left atrial extension of pulmonary tumors through the pulmonary vein is most often associated with primary malignancies and is rarely associated with metastatic disease. We present the first, to our knowledge, reported case of a patient with a history of intracranial meningioma resections presenting with metastatic meningioma to the right lower lobe with extension into the left atrium through the pulmonary vein.

Left atrial extension of metastatic lung tumor via pulmonary vein: report on the first case of Ewing sarcoma

Extension of metastatic lung tumors into the left atrium via pulmonary veins is rare. Here, we report the first case of Ewing sarcoma exhibiting such extension. A 31-year-old man with pulmonary metastasis from Ewing sarcoma presented with a mass in the left lung, extending to the left atrium through the left inferior pulmonary vein. As the patient was considered to be at risk of tumor embolism, the mass was excised surgically.

Perioperative stroke caused by arterial tumor embolism

Rarely, cancer invades a pulmonary vein and subsequently embolizes to the cerebral circulation, causing a stroke. Tumor embolism typically involves large, centrally located lung tumors. We report a case of immediate postoperative stroke caused by an arterial tumor embolism during pulmonary resection of metastatic sarcoma. This case is unique because the resected lesions were smaller than those previously associated with tumor embolism and unusual in that the tumors were peripherally located. Tumor embolization should be considered in the differential diagnosis of stroke after lung cancer surgery even with small, peripherally located pulmonary malignancies.

IMPLICATIONS

We present a case of stroke diagnosed in the recovery room after lung cancer resection. The cause of the stroke was tumor that embolized from the lung to the middle cerebral artery. Tumor embolism should be considered in the differential diagnosis of immediate postoperative stroke after lung cancer surgery.