Cardiac MRI successfully identified a right ventricular mixed tumor-thrombus in a 60-year-old woman with metastatic cervical cancer, preventing potentially fatal complications from thrombolysis.
Case Report (n=1)
No
Cardiac MRI is a crucial diagnostic tool for differentiating cardiac tumors from thrombi in patients with metastatic disease and persistent symptoms despite anticoagulation.
Abstract Introduction Cardiac metastasis from primary cervical carcinoma is notably rare, with fewer than 100 cases reported worldwide 1,2. There is a reported median survival less than three months, and it is usually diagnosed post-mortem 1. These types of metastases are diagnostically challenging since is it the metastatic tumor burden that drives cardiopulmonary symptoms and hemodynamic instability whereas it is thromboembolic burden and cardiac strain that is typically considered more urgent, life-threatening and common diagnosis 3. This unique case highlights the diagnostic value of cardiac MRI in evaluating treatment resistant embolic disease. Case Summary Here we describe a 60-year-old woman with metastatic cervical squamous cell carcinoma who initially presented to our medical center with pleuritic chest pain and dyspnea. Computed tomography pulmonary angiography showed bilateral segmental pulmonary emboli. The patient was started on therapeutic anticoagulation, but her symptoms persisted. A transthoracic echocardiogram revealed a large, irregular right ventricular mass initially interpreted as a thrombus. She was urgently evaluated by Vascular Surgery for consideration of catheter-directed thrombolysis (CDT), which prompted a repeat TTE. This study re-characterized the mass morphology as a large soft tissue mass with possible wall invasion. Given the procedural risk of ventricular wall rupture, she was not a candidate for CDT. Subsequently, cardiac MRI revealed a mixed tumor-thrombus, confounding her initial diagnosis and management. She was transitioned to palliative chemotherapy, and, despite gradual symptom improvement, she expired within one week. Discussion In patients with metastatic disease, persistence of cardiopulmonary symptoms despite being treated with standard therapeutic anticoagulation should prompt clinicians to seek timely advanced imaging, especially when echocardiogram findings do not correlate with significant strain. While TTE is the first pass detection modality, cardiac MRI is considered the gold standard for differentiating tumor from thrombus within the chambers of the heart 4,5 and in this case could have helped avoid potentially fatal complications from CDT. Finally, multidisciplinary collaboration between pulmonology, cardiology, oncology, and radiology is optimal for such complex and diagnostically challenging cases. This abstract is funded by: None
Stern et al. (Fri,) conducted a case report in Metastatic cervical squamous cell carcinoma (n=1). Cardiac MRI vs. Transthoracic echocardiogram was evaluated. Cardiac MRI successfully identified a right ventricular mixed tumor-thrombus in a 60-year-old woman with metastatic cervical cancer, preventing potentially fatal complications from thrombolysis.