Challenging differential diagnosis, Rare disease
Marco Carbonaro, Giulia Russo, Silvia Mezi, Giuseppe Mancuso, Vincenzo Paravati, Francesco Barillà, Carlo Gaudio, Giuseppe Pannarale, Concetta Torromeo
Department of Internal Medicine, Anesthesiological, and Cardiovascular Sciences, University of Rome “Sapienza”, Rome, Italy
Am J Case Rep 2021; 22:e927459
Available online: 2020-12-29
Cardiac metastases of head and neck tumors are extremely rare, and antemortem diagnosis is even rarer. In most cases, patients show symptoms or electrocardiographic abnormalities and expected survival is considerably low.
CASE REPORT: A 72-year-old man was admitted to our cardiology ward with suspected endocarditis 2 months after a right hemiglossectomy for a squamous cell carcinoma. He was asymptomatic and showed no electrocardiogram abnormalities. Echocardiography showed an iso-ipoechogenic round-shaped formation at the right ventricle apex that was suspected to be a metastasis owing to 2 cardiac magnetic resonance imaging examinations showing a significant increase in its volume over 14 days. The patient was evaluated by a multidisciplinary team and referred for first-line chemotherapy with carboplatin, 5-fluoruracil, and cetuximab. He died after almost 4 months of follow-up.
CONCLUSIONS: This case presents a very rare diagnosis as well as some unique features, including the intramyocardial localization, the absence of symptoms, and electrocardiogram abnormalities. Our report shows the relevance of imaging techniques in defining even the most unusual clinical findings, and it emphasizes the significance of early recognition of cardiac masses in order to identify the appropriate medical or surgical therapy for patients.
Keywords: Cardiology, Echocardiography, Head and Neck Neoplasms, Magnetic Resonance Imaging, Neoplasm Metastasis