European Journal of Echocardiography 2008 9(1):76-77; doi:10.1016/j.euje.2006.12.011
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.
A bunch of grapes in the left ventricle
Mohamad Ali Ostovan and
Amir Aslani*
Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
Received 10 December 2006; accepted after revision 27 December 2006; online publish-ahead-of-print 9 March 2007.
* Corresponding author. Cardiology Department, Namazee Hospital, Shiraz, Iran ( PO Box 71935-1334). Tel: +98 917 3131320; fax: +98 711 6279733. E-mail address: draslani{at}yahoo.com.
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Abstract
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A 65-year-old man, heavy smoker, was admitted because of severe
exertional dyspnea and vague chest pain for 2 weeks. A chest
X-ray was taken and revealed a large mass in the left lung field
(
Figure 1). Cytological examination of the percutaneous
needle aspiration of a lymph node in the anterior mediastinum
revealed malignant epithelial cell nests which was strongly
suggestive of squamous cell carcinoma. Transthoracic echocardiography
was performed and revealed multiple mass-like lesions with central
liquefactions in the left ventricle resembling a bunch of grapes.
Keywords: Heart; Tumors; Metastasis; Malignancy
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Illustration
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A 65-year-old man, heavy smoker, was admitted because of severe
exertional dyspnea and vague chest pain for 2 weeks. A chest
X-ray was taken and revealed a large mass in the left lung field
(
Figure 1). Cytological examination of the percutaneous
needle aspiration of a lymph node in the anterior mediastinum
revealed malignant epithelial cell nests which was strongly
suggestive of squamous cell carcinoma. Transthoracic echocardiography
was performed and revealed multiple mass like lesions with central
liquefactions in the left ventricle resembling a bunch of grapes
(
Figure 2) (see Video Clip 1 and 2). Moderate pericardial
effusion was also detected. These findings were highly suggestive
of left ventricular metastasis. Echocardiography is the primary
screening tool for patients with known or suspected intracardiac
tumors. Cardiac tumors can be divided into those that are primary
to the heart and those that are secondary or metastatic. They
can be further divided into benign and malignant types.
1 The
most common benign primary tumor of the heart is the atrial
myxoma.
2 The majority of cardiac malignancies represent metastatic
disease, most commonly from the oesophagus, lung, or breast.
1 Primary cardiac malignancies are relatively rare and can appear
in virtually any chamber.
1,2 Diffuse malignancies, such as lymphoma,
can also involve the heart either primarily or secondarily.
Metastatic disease of the heart is virtually always associated
with pericardial involvement. The appearance of metastatic disease
in the heart is typically mobile echo-dense masses attached
to the endocardium, although isolated intramural masses and
diffuse myocardial invasion have also been noted. In the present
study, we described a case of left ventricular metastasis in
which multiple mass like lesions filled the left ventricular
cavity resembling a bunch of grapes.
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Figure 1 Chest X-ray of a 65-year-old man who was admitted because of severe exertional dyspnea and vague chest pain. A large mass is seen in the left lung field. Cytological examination of the percutaneous needle aspiration of a lymph node in the anterior mediastinum revealed malignant epithelial cell nests which was strongly suggestive of squamous cell carcinoma.
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Figure 2 Transthoracic echocardiography of a 65-year-old man who suffered from squamous cell carcinoma of the lung. Multiple mass like lesions with central liquefactions are seen in the left ventricle resembling a bunch of grapes. Metastasis to the left ventricle was the final diagnosis.
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Supplementary material
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Supplementary material associated with this article can be found in the online version.
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References
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- Bussani R, De Giorgio F, Abbate A, Silvestri F, Cardiac metastases. J Clin Pathol (2006) 10. [Epub ahead of print].
- Sarjeant JM, Butany J, Cusimano RJ. Cancer of the heart: epidemiology and management of primary tumors and metastases. Am J Cardiovasc Drugs (2003) 3:407–421.[CrossRef][Medline]
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