Nodular Pericardial Metastases

Abstract

A 50 year-old male with a 60 pack-year smoking history presented with worsening left upper back pain. He also complained of increasing shortness of breath, difficulty in swallowing, and unintentional 40-pound weight loss over the past four months. Chest computed tomography revealed a large left lower lobe mass (asterisk in Fig. 1A) and numerous soft tissue nodules along the pericardium (arrows in Fig. 1A and B). Echocardiogram also revealed echogenic pericardial nodules (Fig. 1C). Findings were most suggestive of primary bronchogenic malignancy with pericardial metastases. Subsequent biopsy of the left lower lobe mass revealed invasive squamous cell carcinoma. Abdominal magnetic resonance imaging done later for other reasons also demonstrated the enhancing nodules along the pericardium (Fig. 1D). Metastases to the heart are far more common than primary cardiac tumours. The pericardium is the most common