Emergency management of a particular massive pulmonary embolism...
Cardiac intracavitary metastasis is very uncommon. In a 55-year-old man presenting with a massive pulmonary embolism pattern, transthoracic echocardiography (TTE) allowed us to visualize an isolated right ventricular metastasis extended into the pulmonary trunk. It led to the discovery of a primary testis embryonal carcinoma. No intracaval and right atrial localization was observed. Despite an urgent complete cardiac metastasis resection and concomitant orchidectomy, TTE showed on postoperative day 6 an uncommon total intracardiac regrowth spreading again to the pulmonary trunk. Combination chemotherapy (etoposide, cisplatin, and bleomycin) was immediately undertaken. This is the first well-documented case of an isolated right ventricular germ-cell cancer metastasis extended into the pulmonary trunk, without intracaval and right atrial involvement, where the outcome was marked with immediate regrowth despite cardiac surgery and orchidectomy. In conclusion, TTE should be considered alongside germ-cell cancer standard staging procedures.
Talha
Samy
S
Department of Physiology and Functional Explorations, Universitaires de Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France. samy.talha@chru-strasbourg.fr
Cohen
Cyril
C
Kindo
Michel
M
Asmane
Irène
I
Faure
Antoine
A
Eisenmann
Bernard
B
Geny
Bernard
B
Kurtz
Jean-Emmanuel
JE
D018236:Carcinoma, Embryonal / Q000473:pathology* / Q000556:secondary* / Q000628:therapy; D002315:Cardiopulmonary Bypass; D017024:Chemotherapy, Adjuvant; D004452:Echocardiography; D004630:Emergencies; D006338:Heart Neoplasms / Q000556:secondary* / Q000628:therapy; D006352:Heart Ventricles / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009919:Orchiectomy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011664:Pulmonary Valve / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy; D014694:Ventricular Outflow Obstruction / Q000209:etiology