P122 EXTENDED PULMONARY ADENOCARCINOMA INFILTRATING THE LEFT ATRIUM

Abstract

Abstract Cardiac tumors can be primary (benign or malignant) or metastatic (malignant) and can arise in any part of the heart tissue, causing obstruction in the inflow or outflow tract of the valves, thromboembolism, arrhythmias and pericardial disorders. Diagnosis is made by echocardiography and, frequently, by cardiac MRI. The treatment of metastatic malignancies depends on the type and origin of the tumor; however, the prognosis is generally poor.73–year–old patient, he reaches echocardiographic control after having started, 5 months earlier, chemotherapy with weekly carboplatin–paclitaxel scheme for the diagnosis of primary left hilar pulmonary heteroplasia. In medical history: systemic arterial hypertension, iron deficiency anemia and thrombocytopenia in a patient with a history of alcohol–related liver cirrhosis and esophageal varices.On transthoracic echocardiogram (Figures 1 and 2): normal size and bi–ventricular systolic function; mild aortic and mitral insufficiency. Presence of non–mobile isoechoic oval mass adhering to the left atrium, 43 x 27 mm in size, at the outlet of the left pulmonary veins, which does not cause obstruction to the atrio–ventricular blood supply.On CT of chest without and with contrast (Figure 3): primary heteroplastic left hilar pulmonary lesion that infiltrates the left atrium and obliterates the left main bronchus before the bifurcation and the bronchus for the left upper lobe; the corresponding pulmonary vessels also appear infiltrated. The diagnosis was therefore of intracardiac tumor secondary to primary lung lesion.Secondary cardiac tumors are about 20 times more frequent than primary ones. The ability of the tumor to spread to the heart depends on the relationship between the specific biological potential of the primary tumor, the location of the latter and the contractile and draining force of the myocardium.Cardiac metastases can involve, also in combination, pericardium, epicardium, myocardium, endocardium, heart chambers or create endocavitary neoplastic thrombus. Tumors spread to the heart through four possible routes: direct extension, the blood route, the lymphatic route, intracavitary diffusion from the inferior vena cava or pulmonary veins, as in our case.The haemodynamic alterations they cause depend on the engagement of the atrioventricular orifice by the tumor mass.