Image in Cardiology
Cardiac metastasis from colorectal cancer: To be or not to be…
Metástase cardíaca do cancro colorretal: ser ou não ser…
Daniele Pontilloa, Giordano Zampib,
, Amedeo Pergolinic, Vincenzo Polizzic, Denitza Tintid, Paolo Spadacciaa
Corresponding author
a Department of Cardiomyopathies and Heart Failure, Belcolle Hospital, Montefiascone Facility, Montefiascone, (VT), Italy
b U.O.C. Cardiologia, UTIC ed Emodinamica, Division of Cardiology, Belcolle Hospital, Viterbo, Italy
c Department of Cardiovascular Sciences, “S. Camillo-Forlanini” Hospital, Rome, Italy
d Department of Heart and Great Vessels “A. Reale”, Policlinico Umberto I, Sapienza, Università di Roma, Italy
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Cardiologia, UTIC ed Emodinamica, Division of Cardiology, Belcolle Hospital, Viterbo, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Cardiovascular Sciences, “S. Camillo-Forlanini” Hospital, Rome, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Heart and Great Vessels “A. Reale”, Policlinico Umberto I, Sapienza, Università di Roma, Italy" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Metástase cardíaca do cancro colorretal: ser ou não ser…" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1979 "Ancho" => 2500 "Tamanyo" => 300239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Transthoracic echocardiography, apical 4-chamber view, showing a homogenous ovoid mass; (b) transthoracic echocardiography, subcostal view, showing the mass extending from the inferior vena cava to the right atrium; (c) transesophageal echocardiography, off-axis bicaval view, showing invasion of the inferior vena cava; (d) transesophageal echocardiography, bicaval view, showing the thin attachment of the mass to the right atrial inferoposterior wall.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this image presentation, we briefly describe a relatively infrequent clinical situation: cardiac metastasis from colon cancer.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old Caucasian woman was referred to our outpatient clinic for preoperative cardiac evaluation before undergoing elective knee replacement. Transthoracic echocardiography (TTE) showed a homogeneous ovoid mass about 2 cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>a) extending from a dilated inferior vena cava (IVC) to the right atrium (RA) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>b), swinging in synchrony with systole (Movie Clip 1) and not causing right ventricular inflow obstruction. The patient was in good clinical condition, with no signs or symptoms of congestive heart failure. Her past medical history was remarkable for colorectal adenocarcinoma diagnosed seven years before the referral, treated with left hemicolectomy and standard chemotherapy. Serial computed tomography (CT) scans and clinical assessment performed every six months during follow-up were consistent with freedom from disease. To obtain a better definition of the right-sided mass and to exclude any other cause of cardiac invasion besides primary tumor in the presence of a history of cancer, we decided to perform transesophageal echocardiography (TEE), which confirmed the homogenous appearance of the mass and showed a thin attachment of the mass itself to the inferoposterior RA wall (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>c and d, Movie Clip 2). Caval involvement was also confirmed; all other findings were unremarkable. In order to perform a prompt differential diagnosis between atypical RA myxoma and metastatic invasion of the heart, the patient was immediately admitted to our hospital, where CT showed diffuse metastatic involvement of the lungs and liver with total disruption of the right hepatic lobe architecture (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>a) and invasion of the IVC proceeding towards and entering the right atrium (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>b). Peritoneal carcinomatosis was also noted.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient did not undergo surgery due to diffuse metastatic disease, and was treated with standard medical therapy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The case is self-explanatory in highlighting the many pitfalls of differential diagnosis of cardiac masses with ultrasonography. In the presence of a history of cancer we favor “old-fashioned” CT imaging as the best complementary technique to obtain comprehensive information and characterization of the neoplastic disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-15" "fechaAceptado" => "2014-02-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pontillo D, Zampi G, Pergolini A, Polizzi V, Tinti D, Spadaccia P. Metástase cardíaca do cancro colorretal: ser ou não ser… 2014. Rev Port Cardiol. 2014;33:569–570.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0045" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1979 "Ancho" => 2500 "Tamanyo" => 300239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Transthoracic echocardiography, apical 4-chamber view, showing a homogenous ovoid mass; (b) transthoracic echocardiography, subcostal view, showing the mass extending from the inferior vena cava to the right atrium; (c) transesophageal echocardiography, off-axis bicaval view, showing invasion of the inferior vena cava; (d) transesophageal echocardiography, bicaval view, showing the thin attachment of the mass to the right atrial inferoposterior wall.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 530 "Ancho" => 1400 "Tamanyo" => 121548 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Total body computed tomography scan: (a) large metastatic mass in the right hepatic lobe; (b) thoracic level, the arrow indicating the RA filling defect.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 622600 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] 3 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 964502 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000009/v1_201410030041/S2174204914002165/v1_201410030041/en/main.assets" "Apartado" => array:4 [ "identificador" => "28321" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Image in Cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/file/21742049/0000003300000009/v1_201410030041/S2174204914002165/v1_201410030041/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/&text=false" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002165?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 33 | 27 | 60 |
| 2024 September | 47 | 23 | 70 |
| 2024 August | 41 | 27 | 68 |
| 2024 July | 35 | 34 | 69 |
| 2024 June | 41 | 28 | 69 |
| 2024 May | 35 | 24 | 59 |
| 2024 April | 28 | 23 | 51 |
| 2024 March | 42 | 22 | 64 |
| 2024 February | 36 | 18 | 54 |
| 2024 January | 21 | 26 | 47 |
| 2023 December | 21 | 26 | 47 |
| 2023 November | 29 | 19 | 48 |
| 2023 October | 28 | 16 | 44 |
| 2023 September | 19 | 21 | 40 |
| 2023 August | 17 | 15 | 32 |
| 2023 July | 20 | 10 | 30 |
| 2023 June | 35 | 12 | 47 |
| 2023 May | 35 | 23 | 58 |
| 2023 April | 23 | 1 | 24 |
| 2023 March | 33 | 26 | 59 |
| 2023 February | 29 | 17 | 46 |
| 2023 January | 26 | 13 | 39 |
| 2022 December | 26 | 28 | 54 |
| 2022 November | 21 | 23 | 44 |
| 2022 October | 18 | 15 | 33 |
| 2022 September | 22 | 38 | 60 |
| 2022 August | 23 | 32 | 55 |
| 2022 July | 20 | 29 | 49 |
| 2022 June | 22 | 18 | 40 |
| 2022 May | 28 | 28 | 56 |
| 2022 April | 20 | 24 | 44 |
| 2022 March | 19 | 23 | 42 |
| 2022 February | 29 | 36 | 65 |
| 2022 January | 34 | 19 | 53 |
| 2021 December | 16 | 25 | 41 |
| 2021 November | 31 | 27 | 58 |
| 2021 October | 35 | 45 | 80 |
| 2021 September | 20 | 26 | 46 |
| 2021 August | 25 | 32 | 57 |
| 2021 July | 13 | 25 | 38 |
| 2021 June | 22 | 21 | 43 |
| 2021 May | 25 | 33 | 58 |
| 2021 April | 18 | 9 | 27 |
| 2021 March | 37 | 16 | 53 |
| 2021 February | 40 | 18 | 58 |
| 2021 January | 30 | 12 | 42 |
| 2020 December | 25 | 6 | 31 |
| 2020 November | 22 | 7 | 29 |
| 2020 October | 8 | 6 | 14 |
| 2020 September | 43 | 7 | 50 |
| 2020 August | 13 | 2 | 15 |
| 2020 July | 35 | 8 | 43 |
| 2020 June | 32 | 2 | 34 |
| 2020 May | 37 | 1 | 38 |
| 2020 April | 32 | 8 | 40 |
| 2020 March | 37 | 2 | 39 |
| 2020 February | 40 | 13 | 53 |
| 2020 January | 35 | 13 | 48 |
| 2019 December | 26 | 6 | 32 |
| 2019 November | 28 | 5 | 33 |
| 2019 October | 46 | 5 | 51 |
| 2019 September | 11 | 8 | 19 |
| 2019 August | 28 | 8 | 36 |
| 2019 July | 34 | 11 | 45 |
| 2019 June | 37 | 7 | 44 |
| 2019 May | 33 | 6 | 39 |
| 2019 April | 23 | 18 | 41 |
| 2019 March | 26 | 10 | 36 |
| 2019 February | 26 | 8 | 34 |
| 2019 January | 16 | 9 | 25 |
| 2018 December | 23 | 15 | 38 |
| 2018 November | 58 | 5 | 63 |
| 2018 October | 163 | 14 | 177 |
| 2018 September | 61 | 11 | 72 |
| 2018 August | 52 | 5 | 57 |
| 2018 July | 27 | 7 | 34 |
| 2018 June | 32 | 7 | 39 |
| 2018 May | 47 | 10 | 57 |
| 2018 April | 39 | 4 | 43 |
| 2018 March | 48 | 6 | 54 |
| 2018 February | 33 | 7 | 40 |
| 2018 January | 15 | 3 | 18 |
| 2017 December | 49 | 6 | 55 |
| 2017 November | 26 | 12 | 38 |
| 2017 October | 26 | 12 | 38 |
| 2017 September | 31 | 8 | 39 |
| 2017 August | 32 | 18 | 50 |
| 2017 July | 24 | 10 | 34 |
| 2017 June | 47 | 7 | 54 |
| 2017 May | 30 | 6 | 36 |
| 2017 April | 26 | 1 | 27 |
| 2017 March | 50 | 56 | 106 |
| 2017 February | 29 | 4 | 33 |
| 2017 January | 36 | 1 | 37 |
| 2016 December | 40 | 9 | 49 |
| 2016 November | 33 | 3 | 36 |
| 2016 October | 48 | 6 | 54 |
| 2016 September | 42 | 2 | 44 |
| 2016 August | 8 | 1 | 9 |
| 2016 July | 10 | 4 | 14 |
| 2016 June | 12 | 3 | 15 |
| 2016 May | 9 | 2 | 11 |
| 2016 April | 14 | 1 | 15 |
| 2016 March | 14 | 12 | 26 |
| 2016 February | 27 | 20 | 47 |
| 2016 January | 19 | 8 | 27 |
| 2015 December | 28 | 5 | 33 |
| 2015 November | 18 | 5 | 23 |
| 2015 October | 28 | 6 | 34 |
| 2015 September | 27 | 5 | 32 |
| 2015 August | 21 | 9 | 30 |
| 2015 July | 19 | 5 | 24 |
| 2015 June | 13 | 0 | 13 |
| 2015 May | 16 | 9 | 25 |
| 2015 April | 25 | 8 | 33 |
| 2015 March | 17 | 8 | 25 |
| 2015 February | 20 | 2 | 22 |
| 2015 January | 40 | 3 | 43 |
| 2014 December | 24 | 11 | 35 |
| 2014 November | 34 | 14 | 48 |
| 2014 October | 40 | 12 | 52 |
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