Journal Information
Vol. 40. Issue 7.
Pages 523-524 (July 2021)
Share
Share
Download PDF
More article options
Vol. 40. Issue 7.
Pages 523-524 (July 2021)
Image in Cardiology
DOI: 10.1016/j.repce.2021.07.023
Open Access
Cardiac metastasis of primary bronchial carcinoid
Carcinóide brônquico primário com metastização miocárdica
Visits
...
Pedro Gonçalves-Teixeiraa,b,
Corresponding author
, Ricardo Ladeiras-Lopesa,b, Nuno Dias Ferreiraa
a Cardiology Department, Gaia Hospital Center, Vila Nova de Gaia, Portugal
b Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
Article information
Full Text
Download PDF
Statistics
Figures (1)
Full Text

A 46-year-old male was referred to the cardio-oncology clinic for comprehensive cardiovascular assessment. He had a medical history of bronchial carcinoid, having undergone left pneumonectomy 20 years earlier, and was diagnosed with stage IV disease (bone and liver metastasis). A 68Ga-DOTATOC positron emission tomography (PET) scan in July 2019 was notable due to two foci of abnormally high radionuclide uptake at the left inferolateral aspect of the cardiac silhouette (Figure 1, upper left panel).

Figure 1.

Right lower panel: Cardiac magnetic resonance imaging showing two rounded, well-defined intramyocardial high signal intensity lesions in T2-weighted sequences, at the medium and distal segments of the anterolateral wall (dark arrow). These two lesions showed isosignal intensity in T1-weighted images, and intense early (upper right panel, dashed arrow) and late (lower left panel, white arrows) gadolinium enhancement; Upper left panel: Positron emission tomography image shows increased 68Ga-DOTATOC uptake, further supporting the anatomic correspondence of these foci.

(0.31MB).

He had no cardiovascular symptoms. Clinical examination was unremarkable. The electrocardiogram showed sinus rhythm with no ST-T abnormalities. Transthoracic and transesophageal echocardiograms revealed no relevant structural or functional abnormality. Cardiac magnetic resonance imaging (MRI) showed two rounded, well-defined intramyocardial high signal intensity lesions in T2-weighted sequences, at the medium and distal segments of the anterolateral wall (Figure 1, right lower panel, dark arrow). These two lesions showed isosignal intensity in T1-weighted images, and intense early (Figure 1, right upper panel, dashed arrow) and late (Figure 1, left lower panel, white arrows) gadolinium enhancement. The anatomic correspondence between PET and cardiac MRI lesions led to diagnosis of cardiac metastasis of primary bronchogenic carcinoid.

Carcinoid tumors are uncommon neuroendocrine (NE) neoplasms that produce high levels of serotonin. These tumors are more frequently found in the gastrointestinal tract but are primary bronchial in about one quarter of cases. Carcinoid heart disease (CHD) can occur in up to 50% of cases, more often with right-sided valve disease, a consequence of NE mediators progressively seeding over valvular and subvalvular structures, with progressive thickening and dysfunction. Approximately 4% of CHD cases present with cardiac metastasis, with lesions being mostly described as rounded, homogeneous intramyocardial masses. Depending on their functional and/or symptomatic repercussion, along with size considerations, surgical resection may be indicated.

Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2021. Sociedade Portuguesa de Cardiologia
Idiomas
Revista Portuguesa de Cardiologia (English edition)

Subscribe to our newsletter

Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.