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European Journal of Echocardiography Advance Access published online on January 27, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jen340
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Large left ventricular metastasis causing left ventricular outflow tract obstruction and haemolysis

J.M. Coller1,2,*, P. Parente1,2, D. Esmore1,2, G. New1,2, A. Murugasu1,2 and J.C. Cooke1,2

1 Box Hill Hospital, Box Hill, Victoria, Australia
2 The Alfred Hospital, Melbourne, Australia

Received 24 November 2008; accepted after revision 29 December 2008.

* Corresponding author. Tel: +61 413229190. E-mail address: jencoller2003{at}yahoo.com.au


  Abstract

Although post-mortem studies would suggest that cardiac metastases occur frequently, many of these metastases remain clinically silent. However, symptomatic lesions may also remain unrecognized due to overshadowing by other symptoms of the primary malignancy. Patients undergoing treatment for cancer are not routinely screened using echocardiography, unless their chemotherapeutic regimen includes cardiotoxic agents. The current era of research and development of targeted biological agents (such as trastuzumab and epidermal growth factor receptor inhibitors) for cancer may lead to prolonged survival of oncology patients. In future, metastases that were once rare may become increasingly recognized as these new treatments augment the natural history of the disease. There have been several case reports of small, asymptomatic left ventricular metastases, but clinically significant ventricular metastases are very rare. There are no reports in the current literature of a symptomatic ventricular metastasis, occurring in the absence of other metastatic disease. We report an unusual case of a large solitary ventricular metastasis, leading to left ventricular outflow tract obstruction and haemodynamic compromise. Echocardiographic imaging led to the diagnosis of a recurrence of soft-tissue fibrosarcoma 9 years after original resection.

Keywords: Cardiac metastases; Metastasis; Sarcoma


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