A case report of a malignant melanoma in the cardiologic diagnostic workup

Abstract

Background: Cardiovascular imaging plays an important role in identifying pre-existing cardiac comorbidity prior to the decision on cancer therapy and serves as a reference for detecting changes during treatment and long-term follow-up and also in the further identification of a possible cardiac manifestation of the underlying oncological disease.

Case summary: We report the case of an 81-year-old patient with a malignant melanoma. The patient initially was presented before the start of adjuvant therapy with serine/threonine-protein kinase B-Raf/mitogen-activated extracellular signal-regulated kinase inhibitors. Cardiologic staged diagnostics using transthoracic echocardiography, transoesophageal echocardiography, and cardiovascular magnetic resonance imaging (CMR) revealed with a high probability a cardiac manifestation of the underlying disease. The echocardiographic and CMR results as well as the diagnostic workup are presented.

Discussion: Cardiac masses in general have a variety of differential diagnoses. Cardiac metastases are much more common than primary neoplasms in a ratio of about 10:1. Cardiovascular risk stratification is recommended in all patients with cancer before starting potentially cardiotoxic anticancer therapy. Cardiovascular imaging plays an important role for baseline risk stratification but is also the leading diagnostic tool in the differential diagnosis of cardiac tumours and the planning of a potential therapy.

Keywords: Cardiac malignancy; Cardiac mass; Cardiac tumour; Case report; Echocardiography; Malignant melanoma.

Figure 1

Transthoracic echocardiogram: (A) apical four-chamber view demonstrating right atrial mass (arrows), (B) corresponding orthogonal plane in the 3D echocardiogram, (C) subhypoid plane demonstrating right atrial mass (arrow), and (D) corresponding orthogonal plane in the 3D echocardiogram.

Figure 2

(A) Transoesophageal echocardiogram at 52° at the level of the aortic valve demonstrates the cardiac mass in the area of the right atrium (arrows) (B) corresponding orthogonal plane in the multi-plane echocardiogram. (C) Transoesophageal echocardiogram at 94° demonstrates second encapsulated cardiac mass antero-superior to the atrial septum (D) corresponding orthogonal plane in the multi-plane echocardiogram.

Figure 3

Cardiac magnetic resonance images with a steady-state coherent sequence with balanced gradients demonstrates the cardiac mass in the area of the right atrium (arrows) in (A) transversal imaging view, (B) short-axis view, (C) sagittal view, and (D) frontal view.