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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e3181c0a142
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A Hole in the Heart

Weiss, Jared MD*; Geiger, Geoffrey MD†; Lin, Alexander MD†; Langer, Corey MD*

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*Department of Medicine, Division of Hematology and Oncology and †Department of Radiation Oncology, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania.

Disclosure: The authors declare no conflicts of interest.

Address for correspondence: Jared Weiss, MD, Hospital of the University of Pennsylvania, 3400 Spruce Street, 16 Penn Tower, Philadelphia, PA 19104. E-mail:

A 65-year-old man with stage IV adenocarcinoma of the lung first presented with a left pleural mass and malignant pleural effusion in December 2008. He underwent chest tube drainage and received carboplatin and pemetrexed with partial response, but in June 2009, he developed escalating shortness of breath, lower extremity edema, and left side chest pain for 1 week. Physical examination suggested decompensated heart failure. Computed tomography imaging of the chest revealed progression of disease including new pericardial and myocardial metastases invading the left atrium (Figure 1) and right ventricle (Figure 2). A moderate, loculated pleural effusion was present. The patient was admitted to the hospital for diuresis and chemoradiotherapy but experienced cardiac arrest and died on the third hospital day. No autopsy was performed.

Figure 1
Figure 1
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Figure 2
Figure 2
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One large autopsy series reported a 21% prevalence of cardiac metastases on postmortem examination of 460 patients with adenocarcinoma of the lung.1 However, symptomatic disease detected antemortem is quite rare, with only case reports described in the literature.2–5 There are no defined treatment standards for the treatment of this grave situation. One report describes ventriculectomy of an intracavitary pedunculated mass resulting in 7-month survival.2 However, another report describes a patient similar to our patient, with a large right ventricular mass, who also died of hemodynamic compromise shortly after hospital admission.3

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1. Bussani R, De-Giorgio F, Abbate A, et al. Cardiac metastases. J Clin Pathol 2007;60:27–34.

2. Che GW, Liu LX, Zhang EY, et al. Left ventricular metastasis from a primary lung carcinoma. Chin Med J (Engl) 2007;120:2323–2324.

3. Hull JH, Usmani OS. Intra-cavity right ventricular metastasis. Lancet 2006;367:424.

4. Kasai T, Kishi K, Kawabata M, et al. Cardiac metastasis from lung adenocarcinoma causing atrioventricular block and left ventricular outflow tract obstruction. Chest 2007;131:1569–1572.

5. Orcurto MV, Delaloye AB, Letovanec I, et al. Detection of an asymptomatic right-ventricle cardiac metastasis from a small-cell lung cancer by F-18-FDG PET/CT. J Thorac Oncol 2009;4:127–130.

© 2010International Association for the Study of Lung Cancer


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