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Tumour feeding vessel in metastatic intracardiac mass demonstrated by transthoracic Doppler echocardiography
  1. H-J Youn,
  2. W-S Chung,
  3. S-J Hong
  1. younhj{at}

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A 65 year old man was admitted for evaluation of recent onset of weight loss and heart murmur. Physical examination revealed a regular heart rate of 62 beats/min and a blood pressure of 110/70 mm Hg. On cardiac auscultation, a grade 4/6 systolic murmur was heard over the region of the pulmonic valve. Electrocardiography showed low voltage. Chest radiography showed normal cardiac configuration and no pulmonary abnormality was seen.

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(A) Parasternal short axis view obtained by two dimensional echocardiography. The echocardiogram shows a large mass (M) in the right ventricular outflow tract. (B) Endomyocardial biopsy from the right ventricle shows the invasion of the squamous cell carcinoma (haematoxylin and eosin × 100). (C) Colour Doppler echocardiogram shows diastolic flow in the middle of the mass (arrow). (D) Coronary angiogram showing small and tortuous vessels originating from the conus branch of right coronary artery (arrow), suggesting neovascular formation at the site corresponding to the right ventricular outflow tract. M, tumour mass; Ao, aorta; RV, right ventricle

An oesophagogram and endoscopy showed an uncreative and infiltrative oesophageal cancer, which was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography was performed (panel A). Histologically, the cardiac tumour was proven to have the same pathologic findings as an oesophageal cancer, compatible with carcinomatous metastasis (panel B). Interestingly, the feeding vessel in the mass was identified by echocardiography (panel C) and confirmed by coronary angiography (panel D).