Embolic stroke as the initial presentation of an intracardiac metastatic adenocarcinoma of the lung

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Author: 
Narjust Duma, M.D., Yulanka Castro, M.D., Mohleen Kang, M.D. and Larysa Sanchez, M.D.
Abstract: 

Introduction: Metastatic cardiac tumors are relatively uncommon; 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: 69 year old female presented with acute onset right hemiparesis and slurring of speech. Head computed tomography angiogram reported multiple areas of infarction with no evidence of intracranial hemorrhage. On day 2 of admission she developed new neurologic deficits with brain magnetic resonance imaging showing multiple new small ischemic infarcts of the left basal ganglia and left anterior temporal lobe. An embolic source was suspected. Echocardiogram revealed a ~1x1x2cm pedunculated mass originating from the left ventricle. Furthermore, chest CT revealed occlusion of the left mainstem 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 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.

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