Diagnosis of cardiac metastasis by computed tomography: report of 5 cases

Five patients with underlying malignancy were detected antemortemly to have cardiac metastasis by post-enhanced CT scanning. The most common presentations were abnormal heart sounds, electrocardiographic changes and inexplicable heart failure; which lead us to suspect cardiac metastasis. One patient had an "engorged azygous knob" on his chest x-ray film, which provided a clue to possible cardiac metastasis. All of these patients had tumor thrombi in their large tributary veins in addition to the primary tumors. Thus, we advanced the CT scan to the cardiac region and cardiac metastases were, therefore, diagnosed. The tumor thrombi in the large tributary veins seemed to be the source for intracardiac spreading. Cardiac angiographies were performed in 3 patients and confirmed the diagnosis. We conclude that post-enhanced CT scanning is useful in the diagnosis of cardiac metastasis and the presence of tumor thrombi in the large tributary vein is an early sign of cardiac involvement.