Epicardial Metastases Causing Coronary Artery Compression and Myocardial Infarction on [ 18 F]FDG PET-CT

Area of Science:

• Cardio-oncology
• Diagnostic imaging
• Oncology

Background:

• Immune checkpoint inhibitors (ICIs) can cause cardiac adverse events.
• Distinguishing ICI-related myocarditis from other cardiac conditions can be challenging.
• Metastatic cancer can directly impact cardiac structures.

Purpose of the Study:

• To highlight the diagnostic utility of multimodality imaging in a complex cardio-oncology case.
• To illustrate a rare cause of angina in a patient receiving ICI therapy.
• To emphasize the importance of comprehensive imaging in refractory cardiac symptoms.

Main Methods:

• Case report of a 64-year-old woman with metastatic lung adenocarcinoma.
• Initial evaluation included percutaneous coronary intervention (PCI) and cardiac magnetic resonance imaging (CMR).
• Further investigation utilized [18F]FDG PET-CT for definitive diagnosis.

Main Results:

• Initial diagnosis suggested immune checkpoint inhibitor (ICI) myocarditis based on symptoms and CMR.
• Refractory angina and persistent CMR findings despite treatment prompted advanced imaging.
• [18F]FDG PET-CT revealed epicardial metastatic coronary artery compression as the cause of myocardial infarction.

Conclusions:

• Multimodality imaging, particularly [18F]FDG PET-CT, is crucial for accurate diagnosis in cardio-oncology.
• Epicardial metastatic coronary artery compression is a critical differential diagnosis in patients with cardiac symptoms on ICI therapy.
• This case underscores the incremental value of advanced imaging techniques in complex cardiovascular presentations in cancer patients.