Correspondence Address: Prof. Rajesh Gopalan Nair Department of Cardiology, Government Medical College, Kozhikode, Kerala India
Source of Support: None, Conflict of Interest: None
Cardiac metastasis lung malignancy can metastasise to heart. We herein present one such case.
Keywords: Carcinoma lung, left the atrial resection, transesophageal echocardiogram
How to cite this article: Nair RG, Sajeer K, Haridasan V, Krishnan MN, Kumar A, Subramanyan G. Carcinoma Lung Infiltrating into Left Atrium: A Case of Transvenous Extension. Heart India 2015;3:82-3
How to cite this URL: Nair RG, Sajeer K, Haridasan V, Krishnan MN, Kumar A, Subramanyan G. Carcinoma Lung Infiltrating into Left Atrium: A Case of Transvenous Extension. Heart India [serial online] 2015 [cited 2023 May 28];3:82-3. Available from: https://www.heartindia.net/text.asp?2015/3/3/82/157283
Presentation of metastasis to the heart can be as varied as the route of spread. Spectrum of presentations may range from asymptomatic to those having dyspnea, syncope, palpitation, stroke, or even masquerading as infective endocarditis. Cardiac metastasis of tumors may follow various routes like the lymphatic route, hematogenous route, direct or transvenous spread. We hereby present one such case of lung malignancy with transvenous extension to heart.
A 55-year-old woman presented with progressive dyspnea on effort and one episode of hemoptysis. Her symptoms had advanced from class I to class III of New York Heart Association grading over the past 2 years, despite the treatment with bronchodilators. She had no significant medical illness in the past. Clinical examination showed no abnormalities in the cardiovascular system. Findings in the respiratory system examination were dull percussion notes, increased vocal fremitus, vocal resonance, and bronchial breath sounds in the right infra-scapular area. Chest X-ray posterior-anterior view revealed collapse of right lower lobe [Figure 1]a. Computed tomography image of thorax identified a large lung mass infiltrating into the left atrium [Figure 1]b. Trans-thoracic echocardiogram showed a mass projecting into the left atrium from the right upper pulmonary vein [[Figure 2]a, supplementary online Video 1]. Trans-esophageal echocardiogram delineated the presence of huge rounded mass in the left atrium extending from the right upper pulmonary vein [[Figure 2]b-d, supplementary Videos 2,3]. Histopathology after bronchoscopic biopsy revealed squamous cell carcinoma of the lung.
Figure 1: (a) Chest X-ray posterioranterior view showing - collapse of right lower lobe. (b) Computed tomography of the thorax showing a large lung mass infiltrating into the left atrium
Figure 2: (a) Trans-thoracic echocardiogram showing a mass projecting into the left atrium from the right upper pulmonary vein. (b-d) Trans-esophageal echocardiogram showing a huge rounded mass in the left atrium extending from the right upper pulmonary vein
In theory, every malignant tumor can metastasize to the heart, frequency of which is often underestimated.  The most common tumors with potential to cardiac metastasis are carcinomas of the lung, breast, esophagus, lymphoma, leukemia, and malignant melanoma. Pulmonary metastases may reach the heart via the lymphatic route, hematogenous route, also by direct or transvenous extension. Carcinoma around the hilum is more likely to spread into veins than into arteries and may project from a pulmonary vein into the left atrium. Prognosis is relatively favorable if the malignant lesion can be removed completely. In the case of the invasion close to the entrance of the pulmonary vein into the atrium, a partial atrial resection is required. Patients requiring more extensive resection of atrial tissue may require patching with a suitable graft.  In cases of nonsmall cell lung carcinoma with left atrial invasion, complete resection is technically feasible in most instances without cardiopulmonary bypass and left atrial invasion should not be considered as a definitive contraindication to surgery. ,
Stella F, Dell′Amore A, Caroli G, Dolci G, Cassanelli N, Luciano G, et al. Surgical results and long-term follow-up of T(4)-non-small cell lung cancer invading the left atrium or the intrapericardial base of the pulmonary veins. Interact Cardiovasc Thorac Surg 2012;14:415-9.