Alhakeem Mouhsen, Arabi Abdulrahman, Arab Lana, Guerra Ricardo Arbulu
Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA.
Eur J Echocardiogr. 2008 Mar;9(2):323-5. doi: 10.1093/ejechocard/jen066.
Cardiac metastatic squamous cell laryngeal carcinoma is rare. We report the case of a 49-year-old man with recurrent squamous laryngeal carcinoma presenting with right leg acute ischaemia and large mobile right and left cardiac masses. The patient has history of laryngeal squamous cell cancer surgically treated with total laryngectomy, thyroidectomy, and tracheostomy 2 years ago. He was admitted to our intensive care unit with acute right leg pain, left sided chest pain, hypotension 92/55, and tachycardia 112 bpm. On physical exam, he had a faint pulse of his right Posterior Tibial artery with a cold foot, but no discoloration. Heart sounds were normal with no murmur. Initial workup showed a Troponin of 0.27. An electrocardiogram showed sinus tachycardia, with inverted T waves in the Infero-lateral leads. Emergent surgical thrombectomy was done on his right leg with restoration of arterial blood flow to the affected limb. An echocardiogram showed a preserved left ventricular function with multiple areas of echogenic masses in all four cardiac chambers located at the annulus of the tricuspid valve, the right ventricular free wall and along the inter-ventricular septum. No intracardiac shunt was detected by contrast study. Computed tomography scan of the heart confirmed the presence of multiple exophytic intracardiac masses within the left atrium, the right ventricle, interventricular septum, and lateral free wall of the left ventricle. Immunohistochemical staining with cytokeratin of the emboli was consistent with malignant squamous cell carcinoma consistent with metastases of his known laryngeal squamous cell cancer.
心脏转移性喉鳞状细胞癌很罕见。我们报告一例49岁男性，患有复发性喉鳞状细胞癌，表现为右腿急性缺血以及左右心房有可移动的巨大肿物。该患者有喉鳞状细胞癌病史，2年前接受了全喉切除术、甲状腺切除术和气管造口术。他因急性右腿疼痛、左侧胸痛、低血压92/55以及心动过速112次/分入住我们的重症监护病房。体格检查时，其右胫后动脉搏动微弱，足部冰凉，但无变色。心音正常，无杂音。初步检查显示肌钙蛋白为0.27。心电图显示窦性心动过速，下壁和侧壁导联T波倒置。对其右腿进行了紧急手术取栓，恢复了患肢的动脉血流。超声心动图显示左心室功能正常，四个心腔内有多个回声团块，位于三尖瓣环、右心室游离壁和室间隔。对比研究未检测到心内分流。心脏计算机断层扫描证实左心房、右心室、室间隔和左心室侧壁有多个外生性心内肿物。对栓子进行细胞角蛋白免疫组化染色，结果与恶性鳞状细胞癌一致，符合其已知喉鳞状细胞癌的转移。
