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Chiampan A, Lanzoni L, Lanzoni L, Adamo E, Adamo E, Dugo C, Dugo C, Bonapace S, Bonapace S, Castagna F, Castagna F, Barbieri E, Barbieri E. P231 Cardiac metastasis mimicking a myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
We present the case of a 79 years old male patient affected by a lung squamous cell carcinoma (T4 N0 M1a) diagnosed in december 2018 with a 5x5 cm mass in the inferior lobe of the left lung close to the pericardium and a second 5 cm mass in the apical lobe of the right lung. TT echocardiography at that time was normal. Treatment with gemcitabine was scheduled with slight progression of the disease at the CT scan control in april 2019 when initial invasion of the left inferior pulmonary vein was detected. An ECG performed during routine control revealed the presence of q waves and ST segment elevation in the inferior leads. The patient was asymptomatic about the heart but the blood tests revealed a slight increase of HS Troponin I. We decided to repeat the TT echo, which showed the presence of a rounded mobile mass of about 3x2.5 cm in the left atrium close to the upper left pulmonary vein and another formation of about 5x2 cm infiltrating the inferior wall of the left ventricle that appeared akynetic. Both metastatic and thrombotic origins were debated and anticoagulant therapy with LMWH was started. We chose to perform a TE echocardiography, which confirmed the presence of the rounded mass in the left atrium, enlarged as compared to the TT evaluation. At the 3D reconstruction, it appeared to come from the left inferior pulmonary vein, completely occluding it, and expanding to the left superior vein, narrowing but not closing its orifice. The mass was well delimitated, disomogenous and vacuolated, thus confirming its likely neoplastic origin. From the trans-gastric view, we confirmed the large infiltration of the inferior wall of the left ventricle. General conditions of the patients quickly deteriorated and he experienced an ischemic stroke. At the TT echo re-evaluation the mass in the left atrium was greatly reduced as compared to the previous control. Cardiac metastases are a rare and frequently clinically silent occurrence; However, in a minority of cases they may present with ECG alterations such as ST-T segment modifications. In neoplastic patients an ischaemic ECG pattern not following its typical progression, without typical symptoms of ischaemia should rise the suspicion of a cardiac metastasis. In our case the abnormalities could be caused by a loss of viable myocardium secondary to the infiltrating mass or by a compression of the right coronary artery. In this context the echocardiography, both TT and especially TE, is a valuable tool that allow to recognize the real cause of these abnormalities and provides useful informations that enable to distinguish neoplastic mass from a thrombus. The ischaemic stroke was probably due to an embolization of the mass from the left atrium, as confirmed by its important reduction at the last echo control.
Abstract P231 Figure. ECG abnormalities and TE echo alteration
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Affiliation(s)
- A Chiampan
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - L Lanzoni
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - L Lanzoni
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - E Adamo
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - E Adamo
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - C Dugo
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - C Dugo
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - S Bonapace
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - S Bonapace
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - F Castagna
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - F Castagna
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - E Barbieri
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - E Barbieri
- Sacred Heart Hospital of Negrar, Negrar, Italy
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Lanzoni L, Bonapace S, Dugo C, Chiampan A, Adamo E, Anselmi A, Ghiselli L, Inno A, Barbieri E. P1345 Tumors metastatic to the heart :Echo, CT, CMR Imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The frequency of secondary metastatic tumors has increased over years attributable to increased life expectancy in oncologic patients. Imaging with different methods: echo, CMR, CT and PET can provide noninvasive characterization of cardiac masses. We present 3 cases of cardiac metastasis, different for localization in the heart, pathways of dissemination and relation with neighboring structures.
Case 1: a 62-years-old male was admitted to Cardiology department for chest pain and epistaxis. Patient’s medical history was negative for cardiovascular disease. The routine TTE detected a rounded,immobile,intra-myocardial mass (Panel A, fig.1) a the level of the interventricular septum protruding in the LV cavity. The mass was characterized by several anecogenic cavities and echo-contrast showed slight late hyperenhancement of the mass confirming vascularity (fig. 2).CMR gadolinium imaging confirmed late enhancement at the level of the edges of the cavities and in the external border (fig.4). In the suspicion of neuroendocrine tumor, a Gallium-68 dotatate PET/CT was performed with detection of pathological uptake at the abdominal and cardiac level (fig.3).
Case 2: a 64-years-old woman presented with shortness of breath, fatigue and weight loss in the past three months. History of smoke was present and diagnosis of non-small cell lung cancer was made. PET-CT demonstrated pathological uptake at pulmonary, limph-nodes, adrenal, hepatic, bone, muscular and pericardial level (Panel B, fig.1).CMR clearly revealed a massive lesion (7x3x3.5 cm) at the level of the LV antero-lateral wall (fig.2) and TTE SAX view (fig.3) confirmed the presence of a large infiltrative immobile mass in the antero-lateral wall. In the same region the pericardium was irregular and thickened suggestive of pericardial tumor involvement. Some degree of pericardial effusion was also present. The ECG was consistent with ST-T elevation in D1 and aVL in absence of ischemic symptoms (fig.4).Case 3: a 78-years-old man known for non-small cell lung cancer underwent transthoracic echo for monitoring cardiotoxicity.Two–chamber TTE showed a intra-myocardial mass in the inferior wall of LV and another rounded mass at the left atrial level (Panel C, fig.1). Chest CT showed the pulmonary mass with irregular borders, intravascular invasion of left lower pulmonary vein (LLPV) and extension into the left atrium (fig.2).2D/3D TEE well demonstrated the atrial invasion by the mass composed by one more echogenic part inside the llpv and outside in the left atrium a rounded head with several region of cystic colliquation (fig.3). Attached to the rounded head irregular protuberances was noted (thrombus?, fig.4). Conclusion: metastasis to the heart and pericardium are much more common than primary cardiac tumors and occur late in the course of malignant disease. Echo is the initial diagnostic test to evaluate for the presence of cardiac metastases.
Abstract P1345 Figure. Different cases of cardiac metastasis
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Affiliation(s)
- L Lanzoni
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - S Bonapace
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - C Dugo
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - A Chiampan
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - E Adamo
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - A Anselmi
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - L Ghiselli
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
| | - A Inno
- IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - E Barbieri
- IRCSS- Ospedale Sacro Cuore-Don Calabria, Cardiology, Negrar, Verona, Italy
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Arzanauskaite M, Bereda J, Cecchetto A, Casadei F, Lorenzo N, Gizzi G, Huitema MP, Baksi AJ, Mohiaddin RH, Grodecki Ł, Chiampan A, Bonapace S, Albrigi L, Adamo E, Lanzoni L, Barbieri E, Quattrocchi S, Moreo A, Ammirati E, Musca F, Artioli D, De Chiara B, Vigano' E, Cereda A, Giannattasio C, Rodriguez AM, Bartolome S, Darriba MJ, Berzal B, Perez E, Galan L, Gonzalez R, Lavorgna A, Fabiani D, Restauri L, Villani C, Di Eusanio M, Napoletano C, Grutters JC, Van Es HW, Bakker AL, Post MC. Clinical Cases: HIT session - Top of the hub: best clinical cases852A rare cause of severe chest pain and sustained ventricular tachycardia during a football game853Thrombosed iliac venous aneurysm as a extremely rare source of pulmonary thromboembolism8543D transesophageal echo: guide to anticoagulation therapy after surgical closure of the left atrial appendage855A unusual case of giant coronary aneurysm: role of multimodality imaging in the diagnosis and follow-up858Myocardial cleft in a patient with acute coronary syndrome assessed by multimodal imaging859A rare case of subacute left atrial dissection860A case of pulmonary sarcoidosis with severe precapillary pulmonary hypertension and extrinsic compression of the pulmonary artery. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brand M, Stefanidis A, Morbach C, Fan YT, Elremisy DRA, Kuznetsov VA, Carrero C, Almodares Q, Abdulrahim H, Galli E, Galli E, Moreno J, Lerena Saenz P, Ikonomidis I, Galuszka OM, Bonapace S, Clerc OF, Kuznetsov VA, Tadic S, Kataoka A, Abdul Rahman E, Calin A, Antonini-Canterin F, Schwartzenberg SS, Christ M, Roeing J, Amirie S, Grett M, Beko M, Breker I, Wennemann R, Trappe HJ, Lagoudakou S, Vintzilaios K, Mokadem N, Vlachou J, Komatanou E, Korlou P, Kakkavas A, Komninos K, Kranidis A, Gelbrich G, Simon J, Cramer M, Knobeloch F, Tiffe T, Wagner M, Heuschmann PU, Stoerk S, Yang D, Wang X, Chan AK, Cheung SH, Lee AP, Salim FF, Bakhoum SW, Ashour ZA, Soldatova AM, Krinochkin DV, Enina TN, Altamirano C, Pipkin M, Constantin I, Fava A, Diaz Babio G, Masson Juarez G, San Miguel J, Vera Janavel G, Stutzbach P, Wallentin Guron C, Thurin A, Fu M, Kontogeorgos S, Thunstrom E, Johansson MC, Da Silva C, Venkateshvaran A, Nagy AI, Lund LH, Manouras A, Leclercq C, Fournet M, Bernard A, Mabo P, Samset E, Hernandez A, Donal E, Leclercq C, Fournet M, Bernard A, Mabo P, Samset E, Hernandez A, Donal E, Martinez Lugo CML, Zuniga Sedano JZD, Alexanderson EAR, Camilletti JC, Ahmed Abdelrahman M, Raslan H, Ruisanchez Villar C, Cuesta Cosgalla JM, Zarauza Navarro J, Veiga Fernandez G, Rifaie O, Omar AMS, Vlastos D, Frogoudaki A, Vrettou AR, Vlachos S, Varoudi M, Triantafyllidi H, Parissis J, Tsivgoulis G, Lekakis J, Steffens D, Friebel J, Rauch-Krohnert U, Landmesser U, Kasner M, Adamo E, Valbusa F, Ciccio' C, Rossi A, Lanzoni L, Chiampan A, Cecchetto A, Canali G, Barbieri E, Fuchs TA, Stehli J, Benz DC, Graeni C, Buechel RR, Kaufmann PA, Gaemperli O, Yaroslavskaya EI, Krinochkin DV, Kolunin GV, Gorbatenko EA, Dyachkov SM, Jung R, Ilic A, Stojsic-Milosavljevic A, Dejanovic J, Stefanovic M, Stojsic S, Sladojevic M, Watanabe Y, Kozuma K, Yamamoto M, Takagi K, Araki M, Tada N, Shirai S, Tamanaka F, Hayashida K, Ewe SH, Fadzil MA, Najme Khir R, Ismail JR, Lim CW, Chua N, Ibrahim ZO, Kasim SS, Ding ZP, Mateescu AD, Beladan CC, Rosca M, Enache R, Calin C, Cosei I, Botezatu S, Simion M, Ginghina C, Popescu BA, Di Nora C, Poli S, Vriz O, Zito C, Carerj S, Pavan D, Vaturi M, Kazum S, Monakier D, Sagie A, Kornowski R, Shapira Y. Poster Session 2The imaging examination and quality assessmentP520Benefit of early basic transthoracic echocardiography (TTE) in emergency patients performed by physicians with low to intermediate TTE experienceP521Appropriateness criteria in echocardiography. A contemporary necessity in clinical practiceP522Interobserver variability in 2d transthoracic echocardiography impact of scanning and reading on total variability results from the STAAB cohort study quality controlP5233D printing for personalised planning of catheter-based left atrial appendage occlusionP524Central obesity: an independent role or synergistic effect to metabolic syndrome on right atrial structure?P525Dynamics of left ventricular volumes and mortality in patients with early and late effect of cardiac resynchronization therapyP526Variability of thoracic aortic diameters according to gender, age and body surface area. Time to forget absolute cut-off values?P527The association of left ventricular outflow tract velocity time integral to all-cause mortality in elderly patients with heart failureP528Left ventricular myocardial performance and atrioventricular coupling in patients with primary arterial hypertensionP529Interest of a combinatory approach based on traditional left ventricular dyssynchrony parameters and cardiac work estimated by pressure-strain loop curves for the prediction of cardiac resynchronizatP530The evaluation of cardiac performance by pressure-strain loops: a useful tool for the identification of cardiac resynchronization therapy respondersP531Left ventricle cardiac function by 2D-speckle tracking echocardiography in diabetes mellitus population: sub-clinical systolic disfunction studyP532Biphasic tissue doppler mitral annular isovolumic contraction velocities are associated with left ventricular function, isovolumic relaxation, and pulmonary wedge pressure in heart failure patientsP533Abnormal left atrial volumes and strains are associated with increased arterial stiffnes in patients with cryptogenic stroke: a novel pathophysiological pathP534Detection of coronary microvascular disease using two-dimensional speckle-tracking echocardiographyP535Predictive value of a bi-dimensional transthoracic echocardiographic sign of " binary image" to identify the anomalous origin of the left circumflex coronary artery from the right coronary sinusP536Systematic review and meta-analysis of screening for coronary artery disease in asymptomatic diabetic patientsP537Noninvasive screening test for diagnosis of nonobstructive coronary artery disease using echocardiographic criteriaP538Early echocardiography after primary angioplasty, important role in predicting left ventricular remodelingP539Prognostic impact of low-flow severe aortic stenosis in Japanese patients undergoing transcatheter aortic valve implantation: the ocean-tavi registryP540Left ventricular outflow tract geometry and its impact on aortic valve area calculations in aortic stenosis using 3D transoesophageal echocardiography and 2D transthoracic echocardiographyP541Impaired left atrial myocardial deformation predicts postoperative atrial fibrillation after aortic valve replacement in patients with aortic stenosisP542Ejection fraction-velocity ratio in predicting symptoms in severe aortic stenosisP543Incremental value of transesophageal echocardiography in conjunction with transthoracic echocardiography in the assessment of aortic stenosis severity. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Dobutamine stress echocardiography is considered a relatively well-tolerated diagnostic modality, effective in the management of patients with known or suspected coronary artery disease. Adverse effects during testing are relatively frequent, precluding the achievement of a diagnostic end-point in about 5 to 10% of tests. These adverse effects, mostly tachyarrhythmias and arterial hypotension, are usually minor and self limiting. However, severe life-threatening complications, as well as death, also occur. By analysing Medline-quoted literature up to March 1999, we found 35 original studies from a single institution with more than 100 patients, as well as 2 multicentre studies, concerning the feasibility and safety of dobutamine stress echocardiography. In a cumulative total of 26438 tests performed, 79 life-threatening complications (such as acute myocardial infarction, asystole, ventricular fibrillation, sustained ventricular tachycardia or severe symptomatic hypotension) have been reported, giving an incidence of 1 severe adverse reaction per every 335 examinations. In addition, 29 isolated case reports have been published describing life-threatening complications during dobutamine echocardiography. In case reports, 2 deaths have been described, both due to acute cardiac rupture in patients with recent inferior myocardial infarction. Severe adverse reactions during dobutamine echocardiography can be ischaemia independent, and are independent of operator experience and are unpredictable; some complications can be late occurring and long lasting. As a consequence, the procedure must be clearly indicated, written informed consent has to be obtained from the patient, an attending physician must be present during testing, and long term observation of outpatients is useful in order to manage late complications. In conclusion, while the safety of dobutamine stress echocardiography was reported to be outstanding in early reports, further experience presents a substantially more worrying picture. This must be taken into account by both physicians and patients when assessing the risk-benefit profile of the procedure.
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Affiliation(s)
- F Lattanzi
- National Research Council, Institute of Clinical Physiology, University of Pisa, Italy
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