A 56-year-old woman, previously treated for lung adenocarcinoma, presented after a collapse. Clinical assessment showed tachypnoea, hypotension, hypoxaemia, and a greatly increased fixed jugular venous pressure. Portable echocardiogram showed a right ventricular mass consistent with thrombus. The presence of thrombus was confirmed by CT pulmonary angiography (figure, A). Pulmonary emboli were not evident. The patient was aggressively resuscitated and anticoagulated, but remained haemodynamically compromised and died shortly after admission. Post-mortem examination showed an extensive necrotic mass within the right ventricle, occluding the outflow tract (figure, B). Histopathology showed metastatic pulmonary adenocarcinoma. Intra-cavity right ventricular metastases are rare but can cause diagnostic confusion and mimic pulmonary thromboembolism. Recognition of this condition can enable the physician to avoid thrombolysis and, furthermore, consider surgical intervention.
Publication information
Hull JH, Usmani OS. Intra-cavity right ventricular metastasis. Lancet. 367:424, 2006.