Left atrial tumor thrombus with emboli to the brain and distal extremities: A case report

Cardiac metastases are an uncommon phenomenon associated with neoplasms from a variety of primary sites. Pulmonary involvement often accompanies metastases involving the left atrium or ventricle and clinical presentation may be associated with stroke or emboli involving distal sites. We report a patient who presented acutely to the Emergency Department with symptoms of a cerebrovascular accident and bilateral cold pulseless lower extremities. Computerized Tomographic (CT) angiogram of the chest, abdomen, pelvis and lower extremities disclosed pulmonary veins with large filling defects in the right superior and inferior vessels as well as the left atrium and atrial appendage. Mediastinal and hilar adenopathy was detected. The patient had a history of tonsillar squamous cell carcinoma eighteen months prior. The patient underwent operative intervention with removal of a large left intra-atrial mass, histologic evaluation of which demonstrated groups of malignant squamous cells meshed in fibrin clot. The patient died three days post operatively due to multiple brain infarctions.