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Case Reports and Images in Medicine

 
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Case Report
 
Embolic stroke as the initial presentation of an intracardiac metastatic adenocarcinoma of the lung
Narjust Duma1, Yulanka Castro1, Mohleen Kang1, Larysa Sanchez1
1Internal Medicine Resident, Internal Medicine Department, Rutgers-New Jersey Medical School, Newark, New Jersey, United States.

Article ID: 100002Z09ND2015
doi:10.5348/Z09-2015-2-CR-2

Address correspondence to:
Narjust Duma
MD, 59 Maier Street, Belleville
New Jersey
United States, 07109
Phone: 01-206-841-0615
Fax: 973-972-3129

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How to cite this article:
Duma N, Castro Y, Kang M, Sanchez L. Embolic stroke as the initial presentation of an intracardiac metastatic adenocarcinoma of the lung. J Case Rep Images Med 2015;1:5–9.


Abstract
Introduction: Metastatic cardiac tumors are relatively uncommon, and are generally seen with highly disseminated disease. We present a case of a patient with an embolic stroke secondary to a metastatic left ventricular mass from an undiagnosed adenocarcinoma of the lung.
Case Report: A 69-year-old female with no past medical history presented with acute onset right hemiparesis and slurring of speech. On admission patient was found in respiratory failure and shock requiring endotracheal intubation and vasopressors. Head computed tomography (CT) angiogram reported multiple areas of infarction with no evidence of intracranial hemorrhage. On day-2, she developed new neurologic deficits with brain magnetic resonance imaging (MRI) showed multiple new small ischemic infarcts of the left basal ganglia and left anterior temporal lobe. An embolic source was suspected. Echocardiogram revealed a ~1x1x2 cm pedunculated mass originating from the left ventricle. Furthermore, chest CT revealed occlusion of the left main stem bronchus with complete opacification of the left hemithorax by a left-sided pleural effusion. Bronchoscopy was performed recording no visible endobronchial lesions. Cytology from pleural effusion showed malignant cells positive for cytokeratin 7, TTF-1 and Moc-31. These findings were consistent with primary adenocarcinoma of the lung with left ventricle metastasis.
Conclusion: Metastatic disease to the heart is a rare finding. Remarkably, these metastases are clinically silent, especially when obscured by the symptoms of the disseminated tumor disease. In our case, an embolic stroke secondary to a metastatic intracardiac mass makes this initial presentation of adenocarcinoma of the lung a very unique scenario.

Keywords: Cardiac metastasis, Intracardiac tumor, Lung cancer


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Author Contributions
Narjust Duma – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yulanka Castro – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Mohleen Kang – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Larysa Sanchez – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Narjust Duma et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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