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Clinical Images  |   November 2019
Extracardiac Lung Adenocarcinoma
Author Notes
  • From the Department of Cardiovascular Medicine at Ascension Macomb-Oakland Hospital in Warren, Michigan. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  * Address correspondence to Faiza Choudhry, DO, Department of Cardiovascular Medicine, Ascension Macomb-Oakland Hospital, 11800 E Twelve Mile Rd, Warren, MI 48093-3472. Email: faiza.l.choudhry@gmail.com
     
Article Information
Imaging / Pulmonary Disorders / Clinical Images
Clinical Images   |   November 2019
Extracardiac Lung Adenocarcinoma
The Journal of the American Osteopathic Association, November 2019, Vol. 119, 772. doi:https://doi.org/10.7556/jaoa.2019.129
The Journal of the American Osteopathic Association, November 2019, Vol. 119, 772. doi:https://doi.org/10.7556/jaoa.2019.129
  
Extracardiac Lung Adenocarcinoma
eVideo. Underfilling of the left ventricle was appreciated as the mass was compressing the lateral and inferior walls of the left ventricular chamber.
A 67-year-old man presented with dyspnea and hemoptysis for 2 days. His medical history included atrial fibrillation, anemia, chronic kidney disease, hypertension, and tobacco and alcohol dependence. Evaluation revealed atrial fibrillation with a rapid ventricular rate and absent breath sounds on the left lung. Computed tomography (CT) demonstrated left pleural effusion with complete atelectasis, opacification of the lung bronchi, and left-to-right mediastinal shift (image A). Echocardiography revealed a 7.8-cm hyperechoic extracardiac mass moving synchronously with the heart. Underfilling of the left ventricle was due to compression of the lateral and inferior ventricular walls (image B, video). Pathologic findings supported a diagnosis of primary metastatic adenocarcinoma of the lung. Pleural effusions and airway patency were managed with a catheter and radiation. Symptoms improved with palliative paclitaxel and carboplatin. 
Metastases to the heart are much more common than primary cardiac tumors and are generally associated with poor prognosis. Lung carcinoma is the most common cancer to metastasize to the heart and pericardium,1 and the most involved site is the pericardium.2 Cardiac metastases are often found in patients with advance stage of disease. The most important goals for management include palliative care and involvement of multidisciplinary teams of specialists.3 
References
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Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60(1):27-34. [CrossRef] [PubMed]
Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation. 2013;128(16):1790-1794. doi: 10.1161/CIRCULATIONAHA. [CrossRef] [PubMed]
  
Extracardiac Lung Adenocarcinoma
eVideo. Underfilling of the left ventricle was appreciated as the mass was compressing the lateral and inferior walls of the left ventricular chamber.