Lung tumor accompanied by a cardiac mass

Contact address: Edme Roxana Mustafa, Department 3 Cardiology, University of Medicine and Pharmacy Craiova, Romania. E-mail: [email protected] 1 Department 3 of Cardiology, University of Medicine and Pharmacy, Craiova, Romania 2 Department of Thoracic Surgery, University of Medicine and Pharmacy, Craiova, Romania 3 Department of Pathology, Emergency Hospital Craiova, Romania A 58 year old male presented to the emergency department for syncope, dizziness, sweating, shortness of breath when doing less than ordinary physical activity and fatigue. A former smoker, he was diagnosed 1 month ago with left inferior lobe pulmonary tumor from which a sample tissue was collected (by percutaneous transthoracic biopsy) for histological exam and which showed small cell carcinoma. Shortness of breath and fatigue intensifi ed in the last 2 weeks and he had syncope while standing. On admission his general condition was medium, BMI = 19 kg/m2, he was conscious, with dullness at percussion of inferior 2/3 of left thorax, absent breath sounds at this level, SpO2=92%, normal heart size, heart rate was 100 beats/min, without gallop sound or murmurs, BP was 100/70 mmHg, the rest of physical exam was normal. Blood analysis revealed microcytic, hypochromic anemia (Hb=11 g/d) with normal ferritin value, high infl ammation markers (ESR=70 mm/h, PCR=96 mg/ dl), hypoproteinemia (protein=5.9 g/dl), other results were normal. Tumoral markers were measured one month ago when the lung tumor was fi rst diagnosed and had high values: CEA value=7.74 ng/ml (NV 0-0.47 ng/ml), CYFRA 21-2=18.97 ng/ml (NV=0.1-2.3 ng/ml), NSE=64.43 ng/dl (NV=0-16.3 ng/dl). Chest X ray (performed one month ago (Figure 1) showed a large opacity (with an atelectatic component and traction of the mediastinum) occupying the inferior 3⁄4 parts of left lung, fl uid accumulation in the left costophrenic sinus and enlarged pulmonary hilum (Figure 1). First chest CT (performed one month ago) revealed a large tumor of 14/14/18 cm located in the left lung with mediastinal extension, the tumor had necrotic areas and nonhomogenous contrast accumulation; it surrounded left main bronchus, invaded and occluded left inferior lobar bronchus, left superior lobar bronchus was compressed without invasion; limphangitic tracts and subsegmentary atelectasis were present in the superior ventral segment; enlarged mediastinal nodes (up to 20-26 mm) were seen on both sides of the trachea, in the right and left pulmonary hillum; both pulmonary arteries were surrounded by tumor; a small pericardial effusion, an intracardiac extension of the tumor measuring 2.8/2.1 cm and a large left pleural effusion were noticed. According to the CT exam the tumor stage was T4N3. The pleural effusion was drained, it was hemorrhagic fl uid with high protein count (exsudate), with mesothelial cells, free nuclei, frequent lymphocytes, rare polymorphonuclear neutrophils and frequent RBC but Abstract: A 58 year old male diagnosed one month ago with left inferior lobe pulmonary tumor had a transthoracic echocardiography performed after a syncope. A large mass attached to the lateral wall of the the left atrium was found, with a mobile distal part protruding through the mitral valve in diastole. Thoracic CT confi rmed the mediastinal extension of the lung tumor.