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
Autor para correspondência
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" => 346359 ] ] "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" "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" => 346359 ] ] "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" => "/08702551/0000003300000009/v1_201410010215/S0870255114001875/v1_201410010215/en/main.assets" "Apartado" => array:4 [ "identificador" => "357" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Imagens em cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000009/v1_201410010215/S0870255114001875/v1_201410010215/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001875?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 5 | 12 |
| 2024 Outubro | 41 | 19 | 60 |
| 2024 Setembro | 48 | 22 | 70 |
| 2024 Agosto | 44 | 26 | 70 |
| 2024 Julho | 36 | 31 | 67 |
| 2024 Junho | 32 | 13 | 45 |
| 2024 Maio | 44 | 21 | 65 |
| 2024 Abril | 34 | 20 | 54 |
| 2024 Maro | 37 | 28 | 65 |
| 2024 Fevereiro | 25 | 24 | 49 |
| 2024 Janeiro | 32 | 24 | 56 |
| 2023 Dezembro | 31 | 22 | 53 |
| 2023 Novembro | 27 | 20 | 47 |
| 2023 Outubro | 27 | 12 | 39 |
| 2023 Setembro | 31 | 17 | 48 |
| 2023 Agosto | 38 | 24 | 62 |
| 2023 Julho | 25 | 14 | 39 |
| 2023 Junho | 26 | 11 | 37 |
| 2023 Maio | 30 | 18 | 48 |
| 2023 Abril | 20 | 4 | 24 |
| 2023 Maro | 22 | 26 | 48 |
| 2023 Fevereiro | 18 | 12 | 30 |
| 2023 Janeiro | 14 | 13 | 27 |
| 2022 Dezembro | 31 | 19 | 50 |
| 2022 Novembro | 30 | 24 | 54 |
| 2022 Outubro | 20 | 18 | 38 |
| 2022 Setembro | 32 | 23 | 55 |
| 2022 Agosto | 40 | 49 | 89 |
| 2022 Julho | 30 | 39 | 69 |
| 2022 Junho | 31 | 12 | 43 |
| 2022 Maio | 45 | 37 | 82 |
| 2022 Abril | 38 | 20 | 58 |
| 2022 Maro | 28 | 25 | 53 |
| 2022 Fevereiro | 30 | 18 | 48 |
| 2022 Janeiro | 23 | 21 | 44 |
| 2021 Dezembro | 26 | 29 | 55 |
| 2021 Novembro | 44 | 32 | 76 |
| 2021 Outubro | 37 | 49 | 86 |
| 2021 Setembro | 59 | 34 | 93 |
| 2021 Agosto | 34 | 34 | 68 |
| 2021 Julho | 17 | 18 | 35 |
| 2021 Junho | 23 | 14 | 37 |
| 2021 Maio | 25 | 27 | 52 |
| 2021 Abril | 56 | 11 | 67 |
| 2021 Maro | 87 | 20 | 107 |
| 2021 Fevereiro | 53 | 18 | 71 |
| 2021 Janeiro | 40 | 13 | 53 |
| 2020 Dezembro | 31 | 7 | 38 |
| 2020 Novembro | 33 | 12 | 45 |
| 2020 Outubro | 19 | 3 | 22 |
| 2020 Setembro | 57 | 8 | 65 |
| 2020 Agosto | 17 | 5 | 22 |
| 2020 Julho | 44 | 6 | 50 |
| 2020 Junho | 27 | 6 | 33 |
| 2020 Maio | 45 | 7 | 52 |
| 2020 Abril | 40 | 6 | 46 |
| 2020 Maro | 42 | 4 | 46 |
| 2020 Fevereiro | 70 | 12 | 82 |
| 2020 Janeiro | 37 | 8 | 45 |
| 2019 Dezembro | 33 | 3 | 36 |
| 2019 Novembro | 42 | 7 | 49 |
| 2019 Outubro | 35 | 6 | 41 |
| 2019 Setembro | 34 | 2 | 36 |
| 2019 Agosto | 31 | 9 | 40 |
| 2019 Julho | 40 | 12 | 52 |
| 2019 Junho | 24 | 3 | 27 |
| 2019 Maio | 41 | 17 | 58 |
| 2019 Abril | 26 | 20 | 46 |
| 2019 Maro | 54 | 10 | 64 |
| 2019 Fevereiro | 61 | 11 | 72 |
| 2019 Janeiro | 32 | 8 | 40 |
| 2018 Dezembro | 41 | 11 | 52 |
| 2018 Novembro | 69 | 9 | 78 |
| 2018 Outubro | 121 | 16 | 137 |
| 2018 Setembro | 64 | 13 | 77 |
| 2018 Agosto | 43 | 13 | 56 |
| 2018 Julho | 51 | 13 | 64 |
| 2018 Junho | 49 | 4 | 53 |
| 2018 Maio | 68 | 16 | 84 |
| 2018 Abril | 61 | 3 | 64 |
| 2018 Maro | 78 | 14 | 92 |
| 2018 Fevereiro | 66 | 7 | 73 |
| 2018 Janeiro | 43 | 8 | 51 |
| 2017 Dezembro | 86 | 12 | 98 |
| 2017 Novembro | 33 | 8 | 41 |
| 2017 Outubro | 35 | 8 | 43 |
| 2017 Setembro | 47 | 12 | 59 |
| 2017 Agosto | 39 | 12 | 51 |
| 2017 Julho | 31 | 8 | 39 |
| 2017 Junho | 40 | 15 | 55 |
| 2017 Maio | 34 | 11 | 45 |
| 2017 Abril | 28 | 4 | 32 |
| 2017 Maro | 31 | 25 | 56 |
| 2017 Fevereiro | 25 | 3 | 28 |
| 2017 Janeiro | 30 | 9 | 39 |
| 2016 Dezembro | 14 | 5 | 19 |
| 2016 Novembro | 15 | 7 | 22 |
| 2016 Outubro | 52 | 18 | 70 |
| 2016 Setembro | 37 | 9 | 46 |
| 2016 Agosto | 37 | 3 | 40 |
| 2016 Julho | 13 | 7 | 20 |
| 2016 Junho | 5 | 10 | 15 |
| 2016 Maio | 1 | 7 | 8 |
| 2016 Abril | 23 | 4 | 27 |
| 2016 Maro | 35 | 12 | 47 |
| 2016 Fevereiro | 54 | 26 | 80 |
| 2016 Janeiro | 37 | 12 | 49 |
| 2015 Dezembro | 38 | 13 | 51 |
| 2015 Novembro | 30 | 15 | 45 |
| 2015 Outubro | 47 | 16 | 63 |
| 2015 Setembro | 36 | 14 | 50 |
| 2015 Agosto | 37 | 9 | 46 |
| 2015 Julho | 35 | 5 | 40 |
| 2015 Junho | 16 | 3 | 19 |
| 2015 Maio | 28 | 7 | 35 |
| 2015 Abril | 30 | 8 | 38 |
| 2015 Maro | 33 | 7 | 40 |
| 2015 Fevereiro | 30 | 5 | 35 |
| 2015 Janeiro | 35 | 11 | 46 |
| 2014 Dezembro | 35 | 7 | 42 |
| 2014 Novembro | 47 | 22 | 69 |
| 2014 Outubro | 115 | 66 | 181 |
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