Nanda Amit, Khouzam Rami N, Jefferies John, Moon Marc, Makan Majesh
Internal Medicine, University of Tennessee, Memphis, USA.
Cardiology, University of Tennessee, Memphis, USA.
Cureus. 2019 Feb 4;11(2):e4009. doi: 10.7759/cureus.4009.
Metastatic disease to the heart is more often a post-mortem diagnosis due to non-specific symptoms and a low index of suspicion. Our case is a unique presentation of a rare case of cardiac metastasis from oropharyngeal cancer, which eluded echocardiographic diagnosis despite the presence of a hemorrhagic pericardial effusion. The cardiac metastasis, in fact, starts as pericardial seeding, as illustrated by the positron emission tomography (PET) imaging. The pericardial metastatic disease then becomes rapidly invasive into the cardiac chambers, hence presenting as a large mass on the echocardiogram and computed tomography (CT) scan of the chest. This is the first such case of pericardial metastasis from a squamous cell carcinoma of the tongue being reported and highlights the importance of an aggressive multimodality diagnostic approach in cases where such a clinical suspicion exists. While a two-dimensional (2D) echocardiogram is the most readily available modality, we recommend that this is complemented by the use of a three-dimensional (3D) echocardiogram, as well as metabolic and radiologic imaging with PET and CT scans.
由于症状不具特异性且怀疑指数较低，心脏转移性疾病往往是尸检诊断。我们的病例是口咽癌心脏转移罕见病例的独特呈现，尽管存在出血性心包积液，但超声心动图仍未能诊断出来。事实上，正电子发射断层扫描（PET）成像显示，心脏转移始于心包播散。心包转移性疾病随后迅速侵入心腔，因此在超声心动图和胸部计算机断层扫描（CT）上表现为巨大肿块。这是首次报道舌鳞状细胞癌心包转移的此类病例，强调了在存在此类临床怀疑的病例中采用积极的多模态诊断方法的重要性。虽然二维（2D）超声心动图是最容易获得的检查方式，但我们建议使用三维（3D）超声心动图以及PET和CT扫描的代谢和放射成像作为补充。
