Key result
Surgical excision successfully treated a right atrial myxoma presenting as fever, while pacemaker implantation managed complete heart block from an esophageal carcinoma metastasis.
Why the study?
Conduction system metastasis causing complete heart block in patients with oesophageal carcinoma is a rare clinical presentation requiring detailed characterization.
Case Report (n=2)
Right atrial myxomas can present atypically with isolated prolonged fever, and cardiac metastasis from esophageal cancer can cause complete heart block requiring pacing.
Alerts clinicians to atypical fever in myxoma or heart block from esophageal metastasis; hypothesis-generating for these rare presentations.
A young man in his 30s presented to us with multiple episodes of syncope and exertional dyspnoea for the last 2 weeks. He was diagnosed with squamous cell carcinoma of the lower one-third of the oesophagus in 2021 for which he was treated with neoadjuvant chemoradiotherapy, followed by McKeown oesophagectomy. At 2-year follow-up, he had developed a soft tissue swelling in the scalp, which was diagnosed as a tumour recurrence and radiotherapy was initiated. During this period, he presented to the emergency department with multiple episodes of syncope. The patient had bradycardia with a heart rate of 45 beats per minute (bpm). A 12-lead ECG showed complete heart block with wide QRS escape at a rate of 45 bpm. Cardiac MRI revealed a focal T1/T2 hyperintense lesion in the basal interventricular septum, showing central necrosis with peripheral enhancement on early and delayed phase imaging, suggestive of an intracardiac metastasis. Cardiac fluorodeoxyglucose positron emission tomography scan revealed uptake in the basal interventricular septum corresponding to the site on the MRI. The patient was initially kept on temporary pacemaker support followed by implantation of a transvenous dual chamber pacemaker.
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Kumar et al. (2025) conducted a case report in Cardiac tumors (Right atrial myxoma and intracardiac metastasis) (n=2). Surgical excision and pacemaker implantation was evaluated. Surgical excision successfully treated a right atrial myxoma presenting as fever, while pacemaker implantation managed complete heart block from an esophageal carcinoma metastasis.
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