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Case Reports
. 2021 Oct 6;3(13):1545-1550.
doi: 10.1016/j.jaccas.2021.08.012.

Charcoal Heart: Metastatic Melanoma Mimicking Right Atrial Myxoma

Mahmoud Ali  1 , Amina Adil  1 , Rahul Sawlani  2 , Sana Jeffreys  3 , Omar Cheema  1 , Patrycja Galazka  1 , A Jamil Tajik  1
Affiliations
Case Reports

Charcoal Heart: Metastatic Melanoma Mimicking Right Atrial Myxoma

Mahmoud Ali et al. JACC Case Rep. .

Abstract

A 59-year-old woman with history of skin melanoma and complete excision presented with palpitations. Transthoracic echocardiogram revealed right atrial mass attached to interatrial septum. Cardiac magnetic resonance was suggestive of metastatic melanoma. Laboratory tests revealed elevated liver enzymes. Liver ultrasonography showed a large mass positive for metastatic melanoma by biopsy. (Level of Difficulty: Intermediate.).

Keywords: CMR, cardiac magnetic resonance; FDG, fluorodeoxyglucose; ICI, immune checkpoint inhibitors; MM, malignant melanoma; PD-1, programmed death 1; PET, positron emission tomography; RA, right atrial; cardiac neoplasms; metastatic heart disease; metastatic melanoma.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
2-Dimensional Transthoracic Echocardiogram Images Showing an RA Mass (A) Parasternal short-axis view showing the RA mass attached to the interatrial septum. (B) Zoomed para-apical view showing the RA mass measuring 3.5 × 3.3 × 2.3 cm. AV = aortic valve; LA = left atrium; RA = right atrium; RV = right ventricle.
Figure 2
Figure 2
Cardiac Magnetic Resonance (A) Steady-state free precession 4-chamber (4CH) and (B) short-axis (SAX) views showing a large mass in the RA (arrow) attached to the interatrial septum. The (C) 4CH and (D) SAX views show that this mass (arrow) is hyperintense on double inversion recovery (IR) images. The (E) 4CH and (F) SAX views show that this mass (arrow) is also partially hyperintense on triple IR images. The (G) 4CH and (H) SAX views show that this mass (arrow) is actively perfusing on first-pass resting perfusion. The (I) 4CH and (J) SAX views show that this mass (arrow) has heterogenous late gadolinium enhancement. LV = left ventricle; other abbreviations as in Figure 1.
Figure 3
Figure 3
Fluorodeoxyglucose Positron Emission Tomography (A) Axial image of fluorodeoxyglucose (FDG) positron emission tomography (PET) showing an FDG-avid mass in the right atrium (arrow). (B) Coronal image of FDG PET showing an FDG-avid mass in the right atrium (arrow) and in the liver (arrowheads).
Figure 4
Figure 4
2-Dimensional Echocardiogram Images Showing an RA Mass at Different Stages of Treatment (A) Parasternal short-axis (PSAX) and (B) apical 4-chamber views showing an RA mass (yellow star) at the time of diagnosis. (C) PSAX and (D) apical 4-chamber views showing significant reduction in the size of the RA mass at 18 months posttherapy. (E) PSAX and (F) apical 4-chamber views at 26 months posttherapy demonstrating RA mass resolution. Abbreviations as in Figure 1.
See this image and copyright information in PMC

References

    1. Maleszewski J.J., Bois M.C., Bois J.P., Young P.M., Stulak J.M., Klarich K.W. Neoplasia and the heart: pathological review of effects with clinical and radiological correlation. J Am Coll Cardiol. 2018;72:202–227. - PubMed
    1. Bussani R., De-Giorgio F., Abbate A., Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60:27–34. - PMC - PubMed
    1. Glancy D.L., Roberts W.C. The heart in malignant melanoma. A study of 70 autopsy cases. Am J Cardiol. 1968;21:555–571. - PubMed
    1. Norris W. Case of fungoid disease. Edinb Med Surg J. 1820;16:562–565. - PMC - PubMed
    1. Waller B.F., Gottdiener J.S., Virmani R., Roberts W.C. The “charcoal heart”; melanoma to the cor. Chest. 1980;77:671–676. - PubMed

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