Identification of multiple cardiac metastases from nonsmall-cell lung cancer by 18F-FDG PET/CT: A case report

Abstract

Introduction: Multiple cardiac metastases from nonsmall-cell lung cancer are extremely rare. Multiple cardiac metastases detected by F-fluorodeoxyglucose positron-emission tomography/computed tomography (F-FDG PET/CT) have not been previously reported.

Patient concerns: A 53-year-old man was admitted to the hospital with left back pain for 1 month.

Diagnoses: A contrast-enhanced computed tomography (CECT) scan showed a moderately enhancing mass with a necrotic area in the upper left lobe of the lung and a filling defect in the interventricular septum. Two-dimensional transthoracic echocardiography identified a mass attaching to the endocardial surface of interventricular septum. F-FDG PET/CT showed multiple intense F-FDG uptakes in the cardiac region. Nonsmall-cell lung cancer was confirmed by histopathologic examination of the mass in the upper left lobe of the lung.

Intervention: The patient was treated with Gemcitabine chemotherapy.

Outcomes: After 18 months of follow-up, the patient achieved stable disease status according to the Response Evaluation Criteria In Solid Tumors guidelines.

Lessons: Our case demonstrates thatF-FDG PET/CT is a sensitive and feasible imaging modality to diagnosis multiple cardiac metastases.

Figure 1

MIP image (A) showed tracer concentration at the primary site in left lung (double arrows), left pelvic lymph node (arrowhead), and multiple cardiac lesions (arrows). A contrast-enhanced computed tomography (CECT) scan (B) showed a filling defect in the interventricular septum suggestive of tumor (arrow). Axial fused positron-emission tomography/computed tomography (PET/CT) image (C) showed intense ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake in the cardiac region corresponding to the hypodense lesion on axial CECT image (arrow). Axial PET/CT slice showed elevated pathologic ¹⁸F-FDG uptake in the left ventricular corresponding to a small tumor which was slightly less enhanced by contrast medium than normal myocardium on CECT (D and E, arrow). No abnormal finding was showed in the right atrium on CECT (F). However, there was intense focal ¹⁸F-FDG uptake in the right atrium detected on axial PET/CT image (G, arrow).

Figure 2

Two-dimensional echocardiography (A and B) only identified a large well-delineated mass attaching to the endocardial surface of interventricular septum (arrow).