Skip to main content
Download PDF

Large, mobile, transmitral metastastic osteosarcoma presenting as cardiac arrest

Echo Research & Practice volume 2, pages K29–K32 (2015)Cite this article

Abstract

The present case is an unusual one of a 21-year-old female with a primary osteosarcoma and left lung metastasis presenting following a witnessed pulseless electrical activity cardiac arrest. The electrocardiogram was unremarkable. A computed tomography pulmonary angiogram (CTPA) demonstrated a tumour within the left inferior pulmonary veins. Transthoracic echocardiography (TTE) revealed a severely hypokinetic left ventricle and a multi-lobulated, mobile mass arising from one of the left pulmonary veins which prolapsed to varying degrees on a beat-to-beat basis back and forth through the mitral valve into the left ventricle (during ventricular diastole) and retracted back into the left atrium (during ventricular systole). The present case demonstrates the importance of performing TTE in an emergency presentation, its influence on diagnosis and, in the present case, its usefulness in aiding the decision to withdraw life-sustaining treatments. It also highlights the importance of considering urgent intervention for a tumour seen to prolapse through the mitral valve because of the real risk of acute obstruction.

References

  1. Orme RM, Oram MP, McKinstry CE 2009 Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice. British Journal of Anaesthesia 102 340–344. (doi:10.1093/bja/aen378)

    Article  Google Scholar 

  2. Stanko LK, Jacobsohn E, Tam JW, De Wet CJ, Avidan M 2005 Transthoracic echocardiography: impact on diagnosis and management in tertiary care intensive care units. Anaesthesia and Intensive Care 33 492–496.

    Article  CAS  Google Scholar 

  3. Roberts WC 1997 Primary and secondary neoplasms of the heart. American Journal of Cardiology 80 671–682. (doi:10.1016/S0002-9149(97)00587-0)

    Article  CAS  Google Scholar 

  4. Reynen K, Köckeritz U, Strasser RH 2004 Metastases to the heart. Annals of Oncology 15 375–381. (doi:10.1093/annonc/mdh086)

    Article  CAS  Google Scholar 

  5. Suriani R, Konstadt S, Camunas J, Goldman M 1993 Transesophageal echocardiographic detection of left atrial involvement of a lung tumor. Journal of Cardiothoracic and Vascular Anesthesia 7 73–75. (doi:10.1016/1053-0770(93)90123-3)

    Article  CAS  Google Scholar 

  6. Culpepper AL, von Hamm E 1934 Primary carcinoma of the liver with extensive metastasis to the right heart, and tumor-thrombosis of the inferior vena cava. American Journal of Cancer 21 355–362. (doi:10.1158/ajc.1934.355)

    Article  Google Scholar 

Download references

Acknowledgements

Julian Gunn was the physician in charge of the patient’s care during her hospital admission and gives permission for publication of this case report.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. Departments of Cardiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Clare M. Jackson MB ChB & Laurence O’Toole FRCP

  2. Critical Care, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Helen E. Ellis MB ChB

  3. Department of Critical Care, Chesterfield and North Derbyshire Royal Hospital, Top Road, Calow, Chesterfield, S44 5BL, UK

    Mark C. Dodd MB ChB

Authors
  1. Clare M. Jackson MB ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen E. Ellis MB ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark C. Dodd MB ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laurence O’Toole FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Clare M. Jackson MB ChB.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the articles Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the articles Creative Commons licence 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 licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jackson, C.M., Ellis, H.E., Dodd, M.C. et al. Large, mobile, transmitral metastastic osteosarcoma presenting as cardiac arrest. Echo Res Pract 2, K29–K32 (2015). https://doi.org/10.1530/ERP-14-0106

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-14-0106

Echo Research & Practice

ISSN: 2055-0464