Kumagai Naoko, Miura Shin-Ichiro, Toyoshima Hideo, Koga Kaori, Takeda Satoshi, Sato Susumu, Kodama Shiho, Ogawa Masahiro, Matsuo Kunihiro, Nabeshima Kazuki, Ishikura Hiroyasu, Watanabe Kentaro, Saku Keijiro
Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan.
J Cardiol Cases. 2010 Jun 11;2(3):e123-e127. doi: 10.1016/j.jccase.2010.05.005. eCollection 2010 Dec.
A 54-year old man was diagnosed with right lung carcinoma (squamous cell carcinoma, SCC), stage IIIB (c-T2N3M0). Transthoracic echocardiography (TTE) showed a huge 8.9 cm × 1.3 cm tumor in the left atrium (LA) that was invaded by a pulmonary vein, and the tumor moved under the mitral valve at LA systole. After 3 months, he was diagnosed with acute myocardial infarction (AMI) and emergency coronary angiography (CAG) was performed. CAG showed that the distal segment of the right coronary artery was totally occluded. TTE showed that the shape of the mass tip became sharp. He was discharged on hospital day 15. He died 4 months after discharge because of right lung carcinoma with respiratory failure. An autopsy showed that the cause of AMI was tumor embolism. SCC clearly occupied a blood vessel lumen in the distal segment. This is a rare case of AMI due to embolism of lung carcinoma during progression of the disease with direct invasion to the LA. TTE is useful for assessing lung carcinoma invasion.
一名54岁男性被诊断为右肺癌（鳞状细胞癌，SCC），ⅢB期（c-T2N3M0）。经胸超声心动图（TTE）显示左心房（LA）有一个巨大的8.9 cm×1.3 cm肿瘤，该肿瘤被肺静脉侵犯，且在左心房收缩期肿瘤在二尖瓣下移动。3个月后，他被诊断为急性心肌梗死（AMI）并接受了急诊冠状动脉造影（CAG）。CAG显示右冠状动脉远端完全闭塞。TTE显示肿块尖端形状变尖。他于住院第15天出院。出院4个月后因右肺癌伴呼吸衰竭死亡。尸检显示AMI的病因是肿瘤栓塞。SCC明显占据了远端血管腔。这是一例在疾病进展过程中肺癌直接侵犯左心房导致肿瘤栓塞引起AMI的罕见病例。TTE对评估肺癌侵犯有用。
