- Email: [email protected]
Cardiac metastasis from renal cell carcinoma in cardiac CT
Journal of Cardiovascular Computed Tomography xxx (2015) 1e2
Contents lists available at ScienceDirect
Journal of Cardiovascular Computed Tomography journal homepage: www.JournalofCardiovascularCT.com
Case report
Cardiac metastasis from renal cell carcinoma in cardiac CT Abhishek R. Keraliya*, David J. Murphy, Michael L. Steigner, Ayaz Aghayev Department of Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, United States
a r t i c l e i n f o
a b s t r a c t
Article history: Received 1 December 2015 Accepted 7 December 2015 Available online xxx
Cardiac metastases from RCC in the absence of transvenous spread are rare. We present a case of cardiac metastases from RCC demonstrating usefulness of cardiac CT in planning surgical management, which provides superior spatial resolution for evaluation of relationship between the tumor and coronary arteries. © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Keywords: Renal cell carcinoma Cardiac CT PET/CT
Case report A 67-year-old female patient with a history of nephrectomy for renal cell carcinoma 12 years previously reported dry cough and chest tightness. Chest X-ray showed pericardial and left pleural effusions. A PET/CT examination showed a mildly FDG-avid mass in the lateral wall of the left ventricle (Fig. 1). ECG gated, contrastenhanced cardiac CT was performed for surgical planning for mass resection, in particular the relationship to the coronary arteries. It displayed a heterogeneous intramyocardial mass in the lateral wall of the left ventricle supplied by obtuse marginal (OM) branches of the left circumflex coronary artery (Fig. 2A) A 3D reconstruction demonstrates OM branches entering the mass (Fig. 2B). The patient underwent thoracotomy and biopsy. Histopathological evaluation of the cardiac mass was suggestive of metastatic clear cell renal cell carcinoma. Metastatic tumors of the heart are 20 to 40 times more frequent than primary cardiac malignancies, with the most common
primary sites being the lung, breast and esophagus. Pathways for cardiac metastases include lymphatic, hematogenous, transvenous spread, and direct extension. Cardiac metastases from renal cell carcinoma in the absence of transvenous spread (vena caval extension) are rare. Cardiac MRI is the appropriate choice to assess cardiac masses given its excellent contrast resolution and tissue characterization.1 When surgical management is contemplated for localized cardiac masses, patients should also undergo cardiac CT, which provides high quality images with superior spatial resolution for evaluation of relationship between the tumor and coronary arteries.2 References 1. Fussen S, De Boeck BW, Zellweger MJ, et al. Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur Heart J. 2011;32:1551e1560. 2. Kassop D, Donovan MS, Cheezum MK, et al. Cardiac masses on cardiac CT: a review. Curr Cardiovasc Imaging Rep. 2014;7:9281.
* Corresponding author. E-mail address: [email protected] (A.R. Keraliya). http://dx.doi.org/10.1016/j.jcct.2015.12.003 1934-5925/© 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Keraliya AR, et al., Cardiac metastasis from renal cell carcinoma in cardiac CT, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.12.003
2
A.R. Keraliya et al. / Journal of Cardiovascular Computed Tomography xxx (2015) 1e2
Fig. 1. Axial fused FDG-PET/CT image demonstrates mildly FDG avid mass within left ventricular wall. Physiological FDG uptake in cardiac muscle can also be seen on this image (arrows).
Fig. 2. (A) A Coronary CT angiogram four chamber view image reveals a heterogeneously enhancing intramyocardial mass involving the lateral wall of the left ventricle, where the left circumflex coronary artery (arrowhead) is abutting the mass. (B) Segmented three-dimensional (3D) volume rendered image shows the obtuse marginal branches (OM1 and OM2) entering (arrows) the mass (asterisk).
Please cite this article in press as: Keraliya AR, et al., Cardiac metastasis from renal cell carcinoma in cardiac CT, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.12.003
Contents lists available at ScienceDirect
Journal of Cardiovascular Computed Tomography journal homepage: www.JournalofCardiovascularCT.com
Case report
Cardiac metastasis from renal cell carcinoma in cardiac CT Abhishek R. Keraliya*, David J. Murphy, Michael L. Steigner, Ayaz Aghayev Department of Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, United States
a r t i c l e i n f o
a b s t r a c t
Article history: Received 1 December 2015 Accepted 7 December 2015 Available online xxx
Cardiac metastases from RCC in the absence of transvenous spread are rare. We present a case of cardiac metastases from RCC demonstrating usefulness of cardiac CT in planning surgical management, which provides superior spatial resolution for evaluation of relationship between the tumor and coronary arteries. © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Keywords: Renal cell carcinoma Cardiac CT PET/CT
Case report A 67-year-old female patient with a history of nephrectomy for renal cell carcinoma 12 years previously reported dry cough and chest tightness. Chest X-ray showed pericardial and left pleural effusions. A PET/CT examination showed a mildly FDG-avid mass in the lateral wall of the left ventricle (Fig. 1). ECG gated, contrastenhanced cardiac CT was performed for surgical planning for mass resection, in particular the relationship to the coronary arteries. It displayed a heterogeneous intramyocardial mass in the lateral wall of the left ventricle supplied by obtuse marginal (OM) branches of the left circumflex coronary artery (Fig. 2A) A 3D reconstruction demonstrates OM branches entering the mass (Fig. 2B). The patient underwent thoracotomy and biopsy. Histopathological evaluation of the cardiac mass was suggestive of metastatic clear cell renal cell carcinoma. Metastatic tumors of the heart are 20 to 40 times more frequent than primary cardiac malignancies, with the most common
primary sites being the lung, breast and esophagus. Pathways for cardiac metastases include lymphatic, hematogenous, transvenous spread, and direct extension. Cardiac metastases from renal cell carcinoma in the absence of transvenous spread (vena caval extension) are rare. Cardiac MRI is the appropriate choice to assess cardiac masses given its excellent contrast resolution and tissue characterization.1 When surgical management is contemplated for localized cardiac masses, patients should also undergo cardiac CT, which provides high quality images with superior spatial resolution for evaluation of relationship between the tumor and coronary arteries.2 References 1. Fussen S, De Boeck BW, Zellweger MJ, et al. Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur Heart J. 2011;32:1551e1560. 2. Kassop D, Donovan MS, Cheezum MK, et al. Cardiac masses on cardiac CT: a review. Curr Cardiovasc Imaging Rep. 2014;7:9281.
* Corresponding author. E-mail address: [email protected] (A.R. Keraliya). http://dx.doi.org/10.1016/j.jcct.2015.12.003 1934-5925/© 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Keraliya AR, et al., Cardiac metastasis from renal cell carcinoma in cardiac CT, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.12.003
2
A.R. Keraliya et al. / Journal of Cardiovascular Computed Tomography xxx (2015) 1e2
Fig. 1. Axial fused FDG-PET/CT image demonstrates mildly FDG avid mass within left ventricular wall. Physiological FDG uptake in cardiac muscle can also be seen on this image (arrows).
Fig. 2. (A) A Coronary CT angiogram four chamber view image reveals a heterogeneously enhancing intramyocardial mass involving the lateral wall of the left ventricle, where the left circumflex coronary artery (arrowhead) is abutting the mass. (B) Segmented three-dimensional (3D) volume rendered image shows the obtuse marginal branches (OM1 and OM2) entering (arrows) the mass (asterisk).
Please cite this article in press as: Keraliya AR, et al., Cardiac metastasis from renal cell carcinoma in cardiac CT, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.12.003