論文ID: CR-23-0030
A 65-year-old man presented with chest pain. An electrocardiogram (ECG) showed broad ST-segment elevation in the left precordial and inferior leads (Figure A). Coronary angiography revealed no coronary obstructive lesions. A chest radiograph showed a mass shadow in the right upper lung field (Supplementary Figure) that was later diagnosed as adenocarcinoma (Figure H). Contrast-enhanced computed tomography (CT) revealed a large mass at the left ventricular (LV) apex (Figure B). Magnetic resonance imaging (MRI) and positron emission tomography/CT confirmed the diagnosis of myocardial metastasis involving apical portion of the LV wall (Figure C,D). The patient was put on multi-agent chemotherapy with pembrolizumab (anti-PD-L1), carboplatin and pemetrexed. Four months after starting chemotherapy, ST-segment elevation on the ECG subsided (Figure E). Repeat contrast-enhanced CT revealed that the mass lesion at the LV apex had almost disappeared (Figure F). MRI showed residual delayed contrast, suggestive of apical myocardial scarring (Figure G).
(A) Electrocardiogram (ECG) on admission. (B–D) Contrast-enhanced computed tomography (CT; B), magnetic resonance imaging (MRI; C) and positron emission tomography/CT (D). Arrows indicate myocardial metastasis at the LV apex. (E) ECG after chemotherapy. (F,G) Post-therapeutic contrast-enhanced CT (F) and MRI (G). Arrows indicate disappearance of myocardial metastasis. (H) Histological features of the adenocarcinoma. HE, hematoxylin and eosin; LV, left ventricle; TTF-1, thyroid transcription factor 1.
Cardiac metastasis is a rare phenomenon, with a reported incidence in the general population between 0.7% and 3.5%.1 Moreover, myocardial metastasis with ST-segment elevation on the ECG is extremely unusual.2 Although several cases of cardiac metastasis in lung cancer that showed improvement following chemotherapy have been reported previously, the documentation of imaging showing reversal of myocardial metastasis after multi-agent chemotherapy has rarely been provided.
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Please find supplementary file(s);
https://doi.org/10.1253/circrep.CR-23-0030
