Noninfiltrating Adenocarcinoma of the Lung Causing ST-Segment Elevation

Abstract

ST-segment-elevation myocardial infarction is a leading cause of cardiovascular morbidity and death. We describe the case of a 51-year-old woman with advanced adenocarcinoma of the lung who presented with ST-segment elevation in the presence of an extracardiac lung mass but no objective evidence of myocardial ischemia or pericardial involvement. After the patient died of hypoxic respiratory failure, autopsy findings confirmed normal-appearing pericardium and myocardium, and mild-to-moderate atherosclerosis in the coronary arteries. A 4.5 × 4-cm extracardiac left hilar lung mass was confirmed to be poorly differentiated adenocarcinoma of the lung adjacent to the myocardium. The persistent current of injury that had been detected electrocardiographically was thought to occur from direct myocardial compression. ST-segment elevations secondary to direct mass contact on the myocardium should be considered in patients who have a malignancy and ST-segment elevation.

Keywords: Arrhythmias, cardiac/diagnosis; diagnosis, differential; electrocardiography; lung neoplasms/complications/pathology; myocardial infarction/classification.

Fig. 1.

Patient's electrocardiograms A) en route to the hospital and B) upon arrival at the emergency department show ST-segment elevations in leads II, III, aVF, V₅, and V₆

Fig. 2.

Chest radiograph shows an extracardiac left hilar lung mass with bilateral airspace opacities.

Fig. 3.

Chest computed tomogram with contrast shows a 2.2 × 1.9-cm extracardiac left hilar lung mass, 5 months before presentation.

Fig. 4.

Positron-emission tomogram shows a 2.9 × 2.5-cm mass in the left hilar lung with increased fluorodeoxyglucose uptake, 2 months before presentation. Also seen is disease metastatic to the abdomen with multiple peritoneal, liver, left gluteal muscle, and right paraspinous muscle implants.