A case of myocardial metastasis from lung adenocarcinoma presenting as cerebral infarction

Abstract

Introduction: Myocardial metastasis from lung cancer is rarely found in antemortem settings. Herein we present a case of myocardial metastasis from lung adenocarcinoma presenting as cerebral infarction. Case Report: A 78­year­old Japanese female (non­smoker) who had been diagnosed with poorly differentiated lung adenocarcinoma suddenly complained of weakness in the left hand on a regular follow­up visit. Brain non­contrast­ enhanced computed tomography (CT) scan showed no abnormality. Electrocardiography (ECG) showed abnormal Q waves, ST­segment elevation, and inverted T waves in leads II, III, and aVF that had not been demonstrated previously. The results of brain CT scan and symptoms were strongly suggestive of cerebral infarction. Brain magnetic resonance imaging (MRI) with diffusion­weighted imaging performed 5 days after admission showed a small, acute infarct on a knob on the precentral gyrus. Transthoracic echocardiography performed to detect cardiac sources of embolism revealed an intracardiac mass. Cardiac 18F­fluoro­deoxy­glucose positron emission tomography (18F­FDG PET)/CT scan demonstrated increased uptake in the mass. After the patient died, autopsy revealed many metastatic lesions of various sizes accompanied by thrombi on the surface of the ventricular myocardium. Conclusion: Cardiac 18F­FDG PET/CT was useful for diagnosing myocardial metastasis in our patient. The possibility of cardiac metastases should be considered in patients with lung cancer in the event of sudden cerebral infarction.