[Cardiac metastasis of a plasmacytoma with clinical manifestations of an extensive pulmonary embolism. Obstruction of the right ventricular outflow tract].
METHODS
A 48-year-old man with advanced light-chain plasmacytoma was admitted because of severe dyspnoea and tachycardia. Physical examination revealed peripheral cyanosis and signs of right heart failure.


METHODS
The partial pressure of oxygen and CO2 in arterial blood were both reduces (72 mm Hg and 33 mm Hg, respectively). Liver enzyme activities were increased, there was right heart enlargement radiologically and the ECG showed low voltage and typical signs of right heart strain. Echocardiography revealed cardiac metastases of the plasmacytoma with subtotal right ventricular outflow tract obstruction (RVOTO), without any signs of pulmonary emboli.


METHODS
Palliative radiotherapy to the heart reduced the intracardiac tumor size and improved the patients' general condition. The signs of the RVOTO were markedly reduced in both the ECG and the echocardiogram. But after this initial improvement pneumonia developed, of which the patient died. Autopsy revealed radiation pneumonia with extensive fibrosis as the immediate cause of death.


CONCLUSIONS
In patients with advanced neoplasia cardiac metastasis should be included in the differential diagnosis of dyspnoea, tachycardia or hypotension of uncertain etiology. Echocardiography is the diagnostic tool of choice.
Kurzidim
K
K
Klinik und Poliklinik für Innere Medizin II. klaus.kurzidim@klinik.uni-regensburg.de
Gnad
M
M
Hartmann
A
A
Held
P
P
Riegger
G
G
Elsner
D
D
D001784:Blood Gas Analysis; D001859:Bone Neoplasms / Q000150:complications / Q000473:pathology*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D017809:Fatal Outcome; D006338:Heart Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000556:secondary*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010954:Plasmacytoma / Q000150:complications / Q000532:radiotherapy / Q000556:secondary*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology; D017564:Radiation Pneumonitis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014694:Ventricular Outflow Obstruction / Q000209:etiology*
Kardiale Metastasierung eines Plasmozytoms mit der klinischen Manifestation einer ausgedehnten Lungenembolie.