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Arya VK, Gourav KP, Gandhi KA, Singh H. Paraplegia after Pneumonectomy - A Rare Complication. Ann Card Anaesth 2024; 27:79-81. [PMID: 38722129 PMCID: PMC10876134 DOI: 10.4103/aca.aca_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 05/12/2024] Open
Abstract
ABSTRACT Cardiac metastases of lung cancers are common and are associated with serious complications. Locally aggressive lung tumors have the potential to extend into the left atrium via pulmonary veins, which can further complicate by embolizing into the systemic circulation. Pulmonary blastoma (PB) is one of the rare forms of primary lung malignancy and is locally aggressive. We report a rare case of 30 years old male patient who underwent left pneumonectomy for PB. During resection, the tumor was embolized into the descending thoracic aorta, leading to an acute circulatory compromise of both the lower limbs.
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Affiliation(s)
- Virendra K. Arya
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Prasad Gourav
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Komal Anil Gandhi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Fan FS, Chiu CF, Huang HH, Shu HFW. Remarkable Response to Cisplatin Doublet Chemotherapy in Pulmonary Metastasis With Left Atrial Extension From a Nasopharyngeal Cancer. Cureus 2021; 13:e13793. [PMID: 33959428 PMCID: PMC8093781 DOI: 10.7759/cureus.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 60-year-old male patient whose nasopharyngeal carcinoma was brought to complete remission with induction chemotherapy composing of cisplatin plus fluorouracil and subsequent radiotherapy with intent of cure eight years ago presented with dyspnea due to left side massive pleural effusion with pleural seedings, left lower lobe huge space occupying lesion, and left atrial tumor extending from the intrapulmonary lesion through left inferior pulmonary veins. Pleural biopsy revealed a picture of nonkeratinizing squamous cell carcinoma positive for Epstein-Barr virus-encoded small RNAs in situ hybridization, leading to a diagnosis of late pulmonary metastases from the antecedent nasopharyngeal carcinoma. Systemic chemotherapy with initial cisplatin plus paclitaxel and subsequent cisplatin plus gemcitabine brought remarkable resolution to the malignant cardiac and intrathoracic lesions. So far as we know, this is the first case report of left atrial invasion from pulmonary metastasis of a nasopharyngeal carcinoma origin in the English literature.
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Affiliation(s)
- Frank S Fan
- Section of Hematology and Oncology, Ministry of Health and Welfare Taitung Hospital, Taitung County, TWN
| | - Chen-Feng Chiu
- Section of Pulmonology, Department of Internal Medicine, Ministry of Health and Welfare Feng Yuan Hospital, Taichung City, TWN
| | - Hsuan-Hua Huang
- Pathology, Ministry of Health and Welfare Feng Yuan Hospital, Taichung City, TWN
| | - Hwei-Fan Wendy Shu
- Pathology, Ministry of Health and Welfare Feng Yuan Hospital, Taichung City, TWN
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3
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Uygur B, Celik O, Birant A, Demir AR, Erturk M. Echocardiographic detection of left atrium and left ventricle tumoral invasion via the left upper pulmonary vein, leading to the diagnosis of lung cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:565-568. [PMID: 32170864 DOI: 10.1002/jcu.22824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Begum Uygur
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Birant
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali R Demir
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Cardiology Department, Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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4
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Atsumi Y, Saito Y, Hataya H, Fukuzawa R, Yuza Y. Ewing's Sarcoma with Extension into Superior Vena Cava and Right Atrium. Indian J Surg Oncol 2019; 10:98-100. [PMID: 30948882 DOI: 10.1007/s13193-018-0849-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
Ewing sarcoma is rarely shown to develop this intravascular extension so the decision of the initial treatment is more difficult. We report a 7-year-old boy of this sarcoma with extension into superior vena cava (SVC) and right atrium (RA), who was successfully treated with initial surgery. Intravascular extension was observed from the azygous vein to SVC and finally RA. The removal of the intravascular extension was done, 7 days before chemotherapy was started. The initial surgery for the intravascular extension may have decreased a risk of pulmonary tumor embolism and this made the chemotherapy done safe in this patient.
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Affiliation(s)
- Yukari Atsumi
- 1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Yuya Saito
- 2Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Hiroshi Hataya
- 1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Ryuji Fukuzawa
- 3Department of Pathology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Yuki Yuza
- 2Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
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5
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Şeker M, Erol C. Left atrial extension of metastatic renal cell carcinoma via pulmonary vein: A case report. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.450495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Green MS, Hoffman CR, Coleman S. Gluteal Leiomyosarcoma: A Rare Cause of Severe Mitral Stenosis. J Cardiothorac Vasc Anesth 2018; 32:e76-e77. [PMID: 29456048 DOI: 10.1053/j.jvca.2018.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Stuart Green
- Drexel University College of Medicine, Hahnemann University Hospital, Department of Anesthesia, Philadelphia, PA
| | - Christopher Ryan Hoffman
- Drexel University College of Medicine, Hahnemann University Hospital, Department of Anesthesia, Philadelphia, PA
| | - Scott Coleman
- Drexel University College of Medicine, Hahnemann University Hospital, Department of Anesthesia, Philadelphia, PA
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Nakahashi K, Oizumi H, Kato H, Suzuki J, Hamada A, Sasage T, Sadahiro M. Venous phase contrast-enhanced computed tomography facilitates the detection of pulmonary venous tumor thrombus. Gen Thorac Cardiovasc Surg 2018; 66:488-491. [PMID: 29411239 DOI: 10.1007/s11748-018-0898-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/01/2018] [Indexed: 11/29/2022]
Abstract
A 64-year-old woman, with a history of hepatocellular carcinoma, developed recurrent metastatic lung nodules after lung metastasectomy 10 years ago. Computed tomography (CT) revealed tumors in the right middle, and left lower lobes. We planned a right middle lobectomy. Before operating, a contrast-enhanced CT in the pulmonary venous phase revealed a tumor in the pulmonary vein resembling a thrombus, indicating that the CT failed to facilitate accurate diagnosis. Following venous clamping and incision, the intravenous polypoid mass was surgically removed. As contrast-enhanced CT focuses on pulmonary arterial phases and might not detect venous lesions, we highlight the usefulness of venous phase contrast-enhanced CT for detecting pulmonary venous tumor thrombosis. Large lung metastatic carcinomas with venous extension may embolize to distant organs. Therefore, venous phase contrast-enhancement is essential for preoperative assessments of large or persisting metastatic lung tumors.
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Affiliation(s)
- Kenta Nakahashi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Hiroyuki Oizumi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hirohisa Kato
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Jun Suzuki
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Akira Hamada
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takayuki Sasage
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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Left Atrial Mass Invasion from Pulmonary Neoplasm Extension via the Right Upper Pulmonary Vein Presenting as Ipsilateral Stroke. Case Rep Med 2016; 2016:7084234. [PMID: 28053605 PMCID: PMC5178349 DOI: 10.1155/2016/7084234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/15/2016] [Accepted: 11/20/2016] [Indexed: 11/21/2022] Open
Abstract
Left atrial invasion by lung cancer via haematogenous pathways is a relatively uncommon but potentially life-threatening event. While several cardiac complications of cardiac involvement have been previously described, the evolution towards cerebral stroke has been rarely reported. In this case report, we describe an atypical case of haematogenous metastatic invasion of the left atrium from pulmonary neoplasm extension presenting as an ipsilateral stroke whose ASCO classification changed during the clinical management.
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9
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Fukuoka K, Masachika E, Honda M, Tsukamoto Y, Nakano T. Isolated metastases of hepatocellular carcinoma in the left atrium, unresponsive to treatment with sorafenib. Mol Clin Oncol 2014; 3:397-399. [PMID: 25798274 DOI: 10.3892/mco.2014.454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/22/2014] [Indexed: 12/18/2022] Open
Abstract
Isolated metastases in the left atrium that are discontinuous with an intrahepatic hepatocellular carcinoma (HCC) are extremely rare. This is the case report of a 46-year-old male patient with pulmonary metastases from HCC, who presented with a tumor in the left lung, extending to the left atrium through the left pulmonary vein. Two weeks after the initiation of treatment with sorafenib, the tumor metastasized to the left parietal cerebral lobe, with an intracranial hemorrhage. Although the patient underwent gamma knife radiosurgery for the metastatic brain tumor, his condition gradually deteriorated and he succumbed to multiple organ failure 4 months later. Given the severe complications that have been reported in patients with this type of metastasis, immediate multidisciplinary treatment, including surgical resection, should be considered.
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Affiliation(s)
- Kazuya Fukuoka
- Department of Medical Oncology, Sakai Hospital, Kinki University Faculty of Medicine, Sakai, Osaka 590-0132 ; Genetics, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Eriko Masachika
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Miki Honda
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshitane Tsukamoto
- Departments of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Takashi Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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10
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Yu PJ, Hyman KM, Cassiere HA, Fallon B, Vatsia SK, Esposito MJ, Glassman LR. Metastatic meningioma extending into the left atrium through the pulmonary vein. Ann Thorac Surg 2014; 97:2173-5. [PMID: 24882298 DOI: 10.1016/j.athoracsur.2013.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/31/2013] [Accepted: 08/08/2013] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Pey-Jen Yu
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York.
| | - Kevin M Hyman
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York
| | - Hugh A Cassiere
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York
| | - Brian Fallon
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York
| | - Sheel K Vatsia
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York
| | - Michael J Esposito
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York
| | - Lawrence R Glassman
- Department of Pathology, North Shore University Hospital, Manhasset, New York
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11
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Hrdinová M, Omran N, Polanský P, Veselý J, Steiner I, Bělobrádek Z, Šorm Z. Left atrial leiomyosarcoma: A rare cause of mitral valve (pseudo)stenosis. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2013.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Tumors of the pulmonary artery and veins. Semin Ultrasound CT MR 2013; 33:580-90. [PMID: 23168066 DOI: 10.1053/j.sult.2012.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pulmonary vasculature may be involved by different primary and secondary tumors. Poorly differentiated and undifferentiated sarcomas are the most common primary tumors of the pulmonary arteries. They tend to affect the large caliber pulmonary vessels and present with predominantly intraluminal growth. Pulmonary and mediastinal metastasis are common, and prognosis is poor. Clinical and imaging manifestations may mimic those of pulmonary embolism. Dyspnea, chest pain, cough, and hemoptysis are the most common presenting symptoms. Primary sarcomas arising from the central pulmonary veins are less common than their arterial counterpart. Secondary involvement of the pulmonary arteries and veins by primary and metastatic pulmonary malignancies is more common. Tumoral embolism may also affect the pulmonary arteries. They may develop from different intrathoracic and extrathoracic malignancies and may be indistinguishable from venous thromboembolism. It may manifest as cor pulmonale with right cardiac strain and dilated pulmonary arteries. Computed tomography, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography may help in the differentiation between these 2 conditions.
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Affiliation(s)
- Carlos S Restrepo
- Division of Thoracic and Cardiovascular Radiology, Department of Radiology, The University of Texas, Health Science Center, San Antonio, TX 78258, USA.
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Lee P, Kishan AU. Radiotherapy is effective for a primary lung cancer invading the left atrium. BMJ Case Rep 2012; 2012:bcr-2012-006667. [PMID: 22814990 DOI: 10.1136/bcr-2012-006667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Atrial involvement is an uncommon feature of advanced non-small-cell lung cancer, occurring in up to 10% of patients with bronchogenic carcinoma. Additionally, cardiac metastases from other sources are documented in up to 7% of cancer patients at autopsy. Because atrial invasion can lead to systemic embolisation and/or outflow obstruction, it is treated regardless of the overall prognosis. While the gold standard treatment has historically been surgical resection, advances in radiotherapy allow for the safe treatment of cardiac disease. Here we present the case of a woman with pulmonary adenocarcinoma of the left lower lobe that progressed to invade the pulmonary vein and left atrium while maintained on standard chemotherapy. She was treated with intensity-modulated radiotherapy and had a complete response in terms of her atrial disease within 3 months. She suffered no acute toxicity or complications as a result of the radiation therapy.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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