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Everything you need to know about Computed Tomography (CT) & CT Scanning


question

Question 17: 68 year old male with a history of non-small cell lung cancer with increasing shortness of breath and chest pain. What is the best diagnosis?

answer

Diagnosis: Non-Small Cell Lung Cancer Extends into Left Atrium

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Metastatic tumor to the heart: Facts

  • 20-40x more common than a primary tumor
  • Pathways include invasion along the perivascular pathway as well as direct extension

 

Lung cancer extends into the pulmonary veins

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Differential Dx: Tumor vs.Thrombus

  • Often the key differential dx is between a cardiac mass due to tumor and due to thrombus. Some of the key point are noted on the next few slides
  • Thrombi are more common in the left ventricle following myocardial infarction
  • Thrombi are more common in the left atrium in patients with atrial fibrillation especially when they have rheumatic heart disease
  • Thrombi are more common on cardiac walls that are akinetic
  • Masses adjacent to catheter tips are statistically more likely thrombi
  • Tumor extension from the pulmonary veins can result in thrombi being present. Extension of true tumor vs thombus can be difficult unless the tumor enhances

 

Lung cancer extends into the pulmonary veins

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Metastatic Chondrosarcoma to the Pulmonary Veins Extending into the Left Atrium

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© 1999-2019 Elliot K. Fishman, MD, FACR. All rights reserved.