CARDIAC TEMPONADE AS INITIAL PRESENTATION OF ADENOCARCINOMA OF LUNG

Abstract

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary cardiac tumors are extremely uncommon and mostly cardiac tumors are associated with metastases from secondary tumors. Here we describe a case of a patient with primary lung cancer presenting with cardiac tamponade on initial presentation. CASE PRESENTATION: 70 years old male active smoker who presented to the emergency room for the complain of shortness of breath (SOB).He had Chest x-ray done which showed possible lower lobe infiltrates and was given antibiotics and sent home. He again presented to hospital four days later for worsening SOB. A CTA chest was done to rule out pulmonary embolism (PE) which was negative for PE but showed large pericardial effusion and left upper lobe small nodule. Patient had urgent ECHO done which showed very large effusion with tamponade physiology and also showed masses on free wall of left and right ventricles concerning for metastases. Cardiothoracic surgery was consulted and patient underwent pericardial window procedure. He also underwent CT guided biopsy of lung nodule which was consistent with moderately differentiate adenocarcinoma. His pericardial fluid cytology was also consistent with Metastatic adenocarcinoma. Post operatively patient did well and oncology service was consulted for cancer management. DISCUSSION: Metastatic tumors to heart are rare, although the lung cancer is the most common malignant tumor, review of literature showed only few cases of cardiac metastases associated with lung cancer. Various studies have shown the incidence of cardiac metastases ranging between 2.3% to 18.3% 1. Lung Cancer, melanoma and mediastinal primary tumors are the most common cancers associated with cardiac metastases. Bussani and etal reported adenocarcinoma as the most common lung cancer metastasizes to the heart in 26% of cases, followed by squamous cell carcinoma in 23.4% cases. One study showed Epicardium (88%) and pericardium (5-11%) are the most common site of cardiac metastasis and endocardium (< 3%) is the least involve site. 2 Metastases to heart occurs by direct extension, via blood stream, lymphatics and intracavitary diffusion through either the inferior vena cava or the pulmonary veins. Coronary arteries evaluation is recommended as they get compressed by metastatic tumor.3 Chemotherapy, radiotherapy, and surgery are the treatment options but usually prognosis is poor. CONCLUSIONS: Cardiac metastases are rare and high index of suspicion is required as variety of complications may occur due to metastasis including cardiac tamponade needing urgent pericardiocentesis. In patients with cardiac metastases a thorough evaluation should be performed to find secondary cancers. Reference #1: Bussani R, De-Giorgio F, Abbate A. Cardiac metastases. J Clin Pathol 60: 27-34, 2007. Reference #2: Abe S, Watanabe N, Ogura S. Myocardial metastasis from primary lung cancer: myocardial infarction-like ECG change and pathologic findings. Jpn J Med 30: 213-218, 1991. Reference #3: Butany J, Nair V, Naseemuddin A. Cardiac tumours: diagnosis and management. Lancet Oncol 6: 219-228, 2005. DISCLOSURES: No relevant relationships by Michael Caniglia, source=Web Response No relevant relationships by Adnan Khan, source=Web Response No relevant relationships by Sana Khan, source=Web Response No relevant relationships by Ramsha Zafar, source=Web Response