Vol. 44 | No. 2 | July-December 2016 Back

Open Access

Left Atrial Metastasis Presenting as Right-sided Heart Failure in a Patient with Acute T-cell Lymphoblastic Leukemia

Florante T. Paler Jr., Juliana G. Tamayo, Maria Helga F. Sta. Maria
Dec 2016 DOI 10.69944/pjc.4f7a065623

Abstract

Background: Cardiac metastasis is usually seen with lung carcinomas or malignant melanoma, but rarely with  leukemia, and is usually a post-mortem diagnosis. Secondary cardiac tumors arising from the left atrium, where benign myxomas predominate, are uncommon. 

Case presentation: We report a 22-year old Filipino male, recently diagnosed with acute T-cell lymphoblastic  leukemia, presenting with right-sided heart failure symptoms. On work-up, transthoracic echocardiogram showed a mass with mixed echogenicity, irregular borders and broad-base attachment to the anterior and posterior walls of the left atrium. He was treated with nitrates, ivabradine, captopril and digoxin; and subsequently underwent chemotherapy with vincristine, doxurubicin, intrathecal methotrexate and cytarabine. Right-sided heart failure symptoms improved after initiation of chemotherapy. Resolution of the left atrial tumor was documented after completion of induction chemotherapy. 

Conclusion: Cardiac metastasis should be considered in patients with acute lymphoblastic leukemia presenting  with right-sided heart failure. Chemotherapy and supportive cardiac medications should be considered in these cases. Other treatment options should also be investigated.

 

References
  1. Mann, D. MD, Zipes, D. MD, Libby, P. MD, Bonow, R. MD,  Braunwald’s Heart Disease, A Textbook of Cardiovascular Medicine  10th edition. 
  2. Kumar S, Chaudhry MA, Khan I, Duthie DJ, Lindsay S, Kaul P,  Metastatic left atrial synovial sarcoma mimicking a myxoma. J Thorac  Cardiovasc Surg. 2004;128(5):756. 
  3. Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastasis.  J Clin Pathol. 2007 Jan;60(1):27–34. 
  4. Young JM, Goldman IR. Tumor metastasis to the heart. Circulation  1954;9:220–229. 
  5. Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year  experience with a review of 12,485 consecutive autopsies. Arch Pathol  Lab Med. 1993 Oct;117(10):1027-31. 
  6. Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann  Oncol. 2004 Mar;15(3):375-81.
License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.