title: Primary neuroendocrine tumour of the right ventricle presenting with heart failure and cyanosis.
abstract: A 68-year-old woman presented to the emergency department owing to exertional dyspnoea and bilateral leg oedema for 3 weeks. Her vital signs included the following: heart rate of 95 bpm, respiratory rate of 24 breaths/min, oxygen saturation of 73% on room air and a blood pressure of 184/108 mm Hg. Physical examination revealed tachypnoea with clear lungs to auscultation, elevated jugular veins, cyanosis and bilateral pitting oedema. A chest X-ray demonstrated cardiomegaly without obvious pulmonary oedema. A CT of the chest was negative for pulmonary embolus; however, the scan did reveal a large right ventricular (RV) mass. An echocardiogram with bubble study confirmed a patent foramen ovale with significant right-to-left shunting and a large RV mass that significantly obstructed the pulmonary outflow tract. A cardiac biopsy revealed a low-grade neuroendocrine tumour. The patient underwent successful debridement and adjuvant chemotherapy. She improved greatly and was asymptomatic at a 9-month follow-up visit.
authors.affiliation: Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Syed Yaseen
authors.initials: SY
authors.lastname: Naqvi
authors.affiliation: Haematology-Oncology Department, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Henry
authors.affiliation: Cardiovascular Surgery Department, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furukawa
authors.affiliation: Cardiovascular Medicine Department, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Haber
mesh_terms: D000368:Aged; D001706:Biopsy; D003490:Cyanosis / Q000175:diagnosis* / Q000209:etiology; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006338:Heart Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D018358:Neuroendocrine Tumors / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology