Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences Intracardiac Breast Tumor Presenting as Acute Cor Pulmonale Leslie Dawn Wilke1, M. Heather Henderson1, and William G. Petersen1 1
Division of Pulmonary/Critical Care/Sleep Medicine, Department of Internal Medicine, Scott & White Healthcare, Texas A&M Health Science Center, Temple, Texas
Figure 2. Parasternal long axis view on echocardiogram demonstrating the tumor at the level of the tricuspid valve. LA ¼ left atrium; LV ¼ left ventricle; RVOT ¼ right ventricular outflow tract.
Figure 1. Computed tomography angiography of intracavitary mass (ICM) in right ventricle (RV) with extension to the outflow tract to the pulmonary artery (PA).
CASE PRESENTATION An 83-year-old white female 3 weeks postmastectomy for breast carcinoma presented with 5 days of progressive dyspnea and hypoxia. Computed tomography angiography demonstrated a large, 5.5-cm enhancing mass/thrombus arising from the basal aspect of the right ventricle (RV) and by extension nearly occluding the main pulmonary artery (Figure 1). Innumerable, bilateral, noncalcified, pulmonary nodules were seen without evidence of segmental or subsegmental filling defects. Transthoracic echocardiogram confirmed a mass in the RV, depressed RV function, and estimated RV systolic pressure of 70 mm Hg (Figure 2). Biopsy of a lung nodule demonstrated metastatic poorly differentiated adenocarcinoma morphologically consistent with the known primary (Figure 3). The patient elected to be under hospice, and subsequently died 2 weeks after she was discharged. This is the second reported case of an intraventricular breast metastasis causing RV outflow tract obstruction and acute cor pulmonale (1).
Am J Respir Crit Care Med Vol 188, Iss. 9, pp e67–e68, Nov 1, 2013 Copyright ª 2013 by the American Thoracic Society DOI: 10.1164/rccm.201212-2259IM Internet address: www.atsjournals.org
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AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
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2013
Figure 3. High-grade intraductal breast carcinoma (estrogen receptor/ progesterone receptor negative, HER-2/NEU negative) with osteoclast-like giant cell, malignant squamous cell, and sarcomatoid components identified along with areas of necrosis.
Author disclosures are available with the text of this article at www.atsjournals.org.
Reference 1. Labib SB, Schick EC, Isner JM. Obstruction of right ventricular outflow tract caused by intracavitary metastatic disease: analysis of 14 cases. J Am Coll Cardiol 1992;19:1664–1668.
Division of Pulmonary/Critical Care/Sleep Medicine, Department of Internal Medicine, Scott & White Healthcare, Texas A&M Health Science Center, Temple, Texas
Figure 2. Parasternal long axis view on echocardiogram demonstrating the tumor at the level of the tricuspid valve. LA ¼ left atrium; LV ¼ left ventricle; RVOT ¼ right ventricular outflow tract.
Figure 1. Computed tomography angiography of intracavitary mass (ICM) in right ventricle (RV) with extension to the outflow tract to the pulmonary artery (PA).
CASE PRESENTATION An 83-year-old white female 3 weeks postmastectomy for breast carcinoma presented with 5 days of progressive dyspnea and hypoxia. Computed tomography angiography demonstrated a large, 5.5-cm enhancing mass/thrombus arising from the basal aspect of the right ventricle (RV) and by extension nearly occluding the main pulmonary artery (Figure 1). Innumerable, bilateral, noncalcified, pulmonary nodules were seen without evidence of segmental or subsegmental filling defects. Transthoracic echocardiogram confirmed a mass in the RV, depressed RV function, and estimated RV systolic pressure of 70 mm Hg (Figure 2). Biopsy of a lung nodule demonstrated metastatic poorly differentiated adenocarcinoma morphologically consistent with the known primary (Figure 3). The patient elected to be under hospice, and subsequently died 2 weeks after she was discharged. This is the second reported case of an intraventricular breast metastasis causing RV outflow tract obstruction and acute cor pulmonale (1).
Am J Respir Crit Care Med Vol 188, Iss. 9, pp e67–e68, Nov 1, 2013 Copyright ª 2013 by the American Thoracic Society DOI: 10.1164/rccm.201212-2259IM Internet address: www.atsjournals.org
e68
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VOL 188
2013
Figure 3. High-grade intraductal breast carcinoma (estrogen receptor/ progesterone receptor negative, HER-2/NEU negative) with osteoclast-like giant cell, malignant squamous cell, and sarcomatoid components identified along with areas of necrosis.
Author disclosures are available with the text of this article at www.atsjournals.org.
Reference 1. Labib SB, Schick EC, Isner JM. Obstruction of right ventricular outflow tract caused by intracavitary metastatic disease: analysis of 14 cases. J Am Coll Cardiol 1992;19:1664–1668.
