Interventricular septum mass presenting as a late acute coronary syndrome with ST-segment elevation: a case report
Lucas Coroyer1, Philippe Garcon1, Veronique Duchatelle2
1Cardiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France.
Insights
Diagnosing intracardiac masses is challenging. This case highlights how advanced imaging, including contrast echocardiography and CT, aids in identifying these rare tumors and their potential primary sources.
Area of Science:
- Cardiology
- Oncology
- Radiology
Background:
- Intracardiac masses are rare and can present with misleading clinical symptoms.
- Distinguishing between benign and malignant cardiac tumors is crucial, as most malignant masses are metastatic.
Observation:
- An 81-year-old male presented with congestive heart failure and dyspnea, initially suspected as myocardial infarction.
- Doppler and contrast echocardiography revealed an interventricular septal mass with concerning features.
- Cardiac CT identified a coexisting large lung tumor and suspected metastases, later confirmed as squamous cell lung cancer.
Findings:
- The patient had a primary lung cancer with a secondary intracardiac mass.
- Integrated imaging modalities were essential for diagnosing the extent of the disease.
Implications:
- Early and accurate diagnosis of intracardiac masses requires a multimodal imaging approach.
- Contrast-enhanced echocardiography, combined with CT or MRI, can improve diagnostic capabilities for cardiac tumors.
Background:
Intracardiac masses are relatively rare but the diagnosis can be challenging for the cardiologist and the clinical presentation can be misleading. While most of the cardiac masses are benign, malignant masses are mostly metastatic tumours.
Case Summary:
An 81-year-old man was admitted to the cardiology department for congestive heart failure with the complaint of recent dyspnoea. The initial electrocardiogram was suggestive of a late presentation of an anterior myocardial infarction. Blood test showed mild and stable elevation of troponin and brain natriuretic peptide. Doppler-echocardiography revealed an interventricular septal thickening. Contrast echocardiography revealed a mass with a possibly necrotic centre and peripheral hypervascularization. Cardiac computed tomography (CT) confirmed the existence of a cardiac tumour with a hypodense centre and also revealed the presence of a large tumour of the lung's left lower lobe with multiple enlarged lymph nodes associated with possible left adrenal gland metastasis. Computed tomography-guided percutaneous biopsy of the pulmonary mass demonstrated a squamous cell lung cancer which was likely the primary cancer. The patient was discharged home waiting for chemotherapy to start but died a few days later at home of an unknown cause.
Discussion:
Diagnosis of intracardiac mass is difficult, often requiring multiple imaging modalities. Contrast-enhanced echocardiography may help early diagnosis and can be easily implemented with other imaging modalities such as cardiac magnetic resonance imaging or CT.
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