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Case Reports
. 2021 Dec 1;60(23):3749-3753.
doi: 10.2169/internalmedicine.6765-20. Epub 2021 Jun 12.

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer

Masamitsu Kamakura  1 , Ayako Okazaki  1 , Kazuki Ito  1 , Fumihiko Kin  1 , Keisuke Miyajima  1 , Yasuyo Takashima  1 , Tomoyuki Watanabe  1 , Yoshitaka Kawaguchi  1 , Yasushi Wakabayashi  1 , Mitsuru Asano  2 , Yuichiro Maekawa  3
Affiliations
Case Reports

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer

Masamitsu Kamakura et al. Intern Med. .

Abstract

An 82-year-old woman with a history of bladder cancer presented with dyspnea and loss of consciousness. Contrast-enhanced computed tomography revealed pulmonary embolism, and emergency thrombus aspiration therapy was performed, but the thrombus was not aspirated. Echocardiography showed mobile masses in the heart and a right-to-left shunt due to a patent foramen ovale (PFO). Magnetic resonance imaging showed multiple cerebral infarctions. Surgical thrombectomy and PFO closure were performed, and the patient was diagnosed with intracardiac metastasis of bladder cancer based on intraoperative histopathology. This is a rare case of concomitant pulmonary and cerebral tumor embolism and intracardiac metastasis from bladder cancer.

Keywords: intracardiac metastasis; paradoxical embolism; patent foramen ovale; pulmonary artery aspiration cytology; pulmonary tumor embolism.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(A) Contrast-enhanced computed tomography image of the chest showing filling defects in both pulmonary arteries (arrow). (B) Pulmonary angiography showing filling defects in the left main pulmonary artery and both branches.
Figure 2.
Figure 2.
Transthoracic echocardiogram on the third day. (A) Parasternal long-axis view. The image demonstrated a mass on the mitral valve and mitral chordae tendineae (arrow). (B) Homogenous spherical mass on the mitral valve and tricuspid chordae tendineae (arrow) and expansion of the coronary sinus (arrowhead). (C) Parasternal short-axis view. This indicated dilatation of the right ventricle and flattening of the interventricular septum. Transesophageal echocardiography on the fourth day after admission. (D) View obtained at 60°. A blood flow indicated the presence of a right-to-left shunt due to the patent foramen ovale (PFO). The linear structure (arrow) in the right atrium straddled the PFO. (E) The view was obtained at 130°. It demonstrated the mobile mass (arrow) attached to the mitral valve moving back and forth between the left ventricle and the aorta beyond the aortic valve.
Figure 3.
Figure 3.
Magnetic resonance diffusion-weighted imaging of the brain showing scattered hyperintensities in the bilateral cerebral hemispheres and cerebellum (arrows).
Figure 4.
Figure 4.
Postoperative pathological examination showing high-grade urothelial carcinoma infiltration (arrow) in the cardiac muscle tissue (arrowhead, ×50, scale bar=0.25 mm).
Figure 5.
Figure 5.
Four-chamber view (A) and parasternal view (B) of transthoracic echocardiography after the surgery (6 days after admission). They indicated new mobile masses in the right atrium and inferior vena cava (arrow). They were not found immediately after the operation.
See this image and copyright information in PMC

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