Acute myocardial infarction as presentation of an infiltrative lung neoplasia

Abstract

We report the case of a 51-year-old woman who presented with acute myocardial infarction as initial symptom of an infiltrative lung neoplasia. The patient was admitted to our center following an out-of-hospital cardiac arrest due to ventricular fibrillation which was cardioverted. On electrocardiography an anterior wall ST-elevation was found and urgent coronary angiography was performed. Left anterior descending coronary artery was occluded and after thrombus aspiration, an image of diffuse loss of lumen diameter and absence of coronary branches was compatible with an extrinsic compression. Such findings along with a lingula consolidation on chest X-ray examination suggested a thoracic neoplasia. Enhanced-chest computed tomography showed a mass located in the lingula with extensive mediastinal infiltration involving pericardium and myocardium. Anatomopathologic examination confirmed the presence of lung adenocarcinoma. <Learning objective: In patients with neoplasms should be suspected cardiac tumor infiltration in those with acute myocardial infarction. Since differential diagnosis between true AMI electrocardiographic (ECG) changes and pseudo-AMI ECG changes in patients with secondary cardiac tumors assumed to be difficult, such TTE or IVUS findings of extra-cardiac tumor could help physicians to make an accurate diagnosis.>.

Keywords: Cardiac metastasis; Lung adenocarcinoma; Myocardial infarction.

Fig. 1

Electrocardiography showed anterior and lateral wall ST-segment elevation.

Fig. 2

Apical four-chamber view transthoracic echocardiogram. The image suggests extrinsic compression and likely invasion of the lateral wall of the left ventricle (white arrow).

Fig. 3

Left coronary angiogram in right anterior oblique cranial projection showing a large-caliber left anterior descending coronary artery, with loss of luminal diameter all along the mid and distal segments and absence of diagonal branches (white arrows).

Fig. 4

(A) Vascular luminal narrowing irregular without atheromatous plaque, dissection or thrombus. Increased perivascular refraction at the level of tumor lesion. (B) Coronary vessel lumen proximal to the site of occlusion.

Fig. 5

(A) Thoracic transverse CT-scan cut at mesoventricular level. Metastatic invasion of both the pericardium anterior to the right ventricle (arrows) and of the left ventricular free wall is evident. (B) Thoracic transverse computed tomography (CT)-scan cut at the level of the origin of the great vessels. Note the large lingular tumor which infiltrates the mediastinal pleura and the inferior and lateral wall of the main pulmonary artery (white arrow).