title: A case of double cancers with myocardial metastasis mimicking acute myocardial infarction both on an electrocardiogram and on Tc-99m-MIBI myocardial SPECT.
abstract: We report a rare case of double cancers with myocardial metastasis presenting acute myocardial infarction (AMI)-like findings both on an electrocardiogram (ECG) and on Tc-99m-MIBI myocardial SPECT. The ECG showed abnormal Q-waves and ST-segment elevation in leads V1-V4, and Tc-99m-MIBI SPECT showed a photon deficient area in the anteroseptum. These findings were suggestive of AMI, but the patient had been simultaneously suffering from two adenocarcinomas, which were lung cancer and gastric cancer, and consecutive ultrasonic cardiography (UCG) demonstrated a growing mass lesion in the septal aspect of the left ventricle. After a month he died of severe heart failure. The histological diagnosis of a specimen of the cardiac mass lesion was invasive adenocarcinoma infiltrating to the heart, which revealed that the myocardial metastasis had mimicked AMI. This case shows that it is difficult to distinguish between myocardial infarction and myocardial metastasis with myocardial perfusion SPECT. It is necessary to consider the possibility of myocardial metastasis when a patient with malignancy presents AMI-like findings.
authors.affiliation: Department of Nuclear Medicine, Kanazawa University School of Medicine, Japan. konichan@ma4.justnet.ne.jp
authors.forename: S
authors.initials: S
authors.lastname: Konishi
authors.forename: T
authors.initials: T
authors.lastname: Kojima
authors.forename: K
authors.initials: K
authors.lastname: Ichiyanagi
authors.forename: S
authors.initials: S
authors.lastname: Kinihiko
authors.forename: K
authors.initials: K
authors.lastname: Yokoyama
authors.forename: J
authors.initials: J
authors.lastname: Taki
authors.forename: K
authors.initials: K
authors.lastname: Nakajima
authors.forename: T
authors.initials: T
authors.lastname: Michigishi
authors.forename: N
authors.initials: N
authors.lastname: Tonami
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006338:Heart Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D013274:Stomach Neoplasms / Q000175:diagnosis; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi