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Description
A previously healthy 44-year-old woman with new bilateral pleural effusions had an echocardiogram ordered as part of the work up. It showed a small, free-flowing effusion circumferential to the heart. A mass was noted and it was adherent to the myocardium, mainly apically and anteriorly (figure 1A–C). The ventricular septum was hypermobile (video 1) and the right ventricular outflow tract was thickened (figure 2, videos 2 and 3). The velocity of the septum (figure 3A) was increased compared to the velocity of the lateral wall (figure 3B) and there was evidence for increased right–left ventricle interaction (figure 4), consistent with a constrictive pattern. The inferior vena cava and the hepatic veins were also dilated indicating volume overload (figure 5).
Positron emission tomography-CT scan demonstrated metastases to the femur, spine and brain. A hypermetabolic pericardial mass was noted, also consistent with metastatic disease (figure 6). The patient was diagnosed with T2N3M1, stage 4 lung adenocarcinoma. Given the extent of the disease and the unfortunate late diagnosis, a plan was made to begin palliative chemotherapy and radiation therapy. The patient died a few weeks later.
Echocardiography remains a good tool for the detection of pericardial disease.1 Once a pericardial mass is detected by echocardiography, the prognosis is usually grave.2 ,3 Despite the presence of some unique and distinctive echocardiographic findings that are highly suggestive of pathological cardiac involvement, cardiac CT and cardiac MRI are always required for confirmatory purposes.1
Footnotes
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Competing interests None.
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Patient consent Not obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.