[Cerebral embolism as the first manifestation of left ventricular metastatic bronchial carcinoma]

Commonly the diagnosis of cardiac metastases in extracardiac cancer is difficult because of predominant symptoms of the underlying disease. In the reported case, a cerebral embolization was the first manifestation of a bronchogenic carcinoma with left ventricular metastasis. A 58-year-old male patient was admitted to the hospital with symptoms of an incomplete left-sided hemiparesis that occurred without prodromi. Other clinical abnormalities were not found. The two-dimensional echocardiogram showed a small space-occupying lesion in the left ventricle. Clinical symptoms completely disappeared within 3 days of heparin therapy. In order to prevent repeated embolization (after angiographic exclusion of coronary stenoses), the tumor was excised by cardiac surgery. In the histologic examination, malignant tumor cells were found. As primary origin, a small peripheral bronchogenic carcinoma with (clinically silent) additional metastases to the left adrenal gland and the right pelvic bone was found. The patient died 7 months later because of progressive metastatic cancer disease. Thus (on one hand) the reported case underlines the value of echocardiographic examination in suspected heart manifestation of cancer disease. On the other hand, in patients with heart tumors prior to curative therapy, additional diagnostic procedures (such as CT or MRI) should be performed in order to detect extracardiac tumor manifestations.