Obstruction of Right Ventricular Outflow Tract by Extended Cardiac Metastasis from Esophageal Cancer

ABSTRACT

We report a case in whom there was right ventricular outflow tract obstruction by extended metastasis from esophageal cancer. A 65-year-old man was admitted to hospital for evaluation of recent onset of weight loss of recent onset and a heart murmur. Physical examination revealed a regular heart rate of 62 beats per minute and a blood pressure of 110/70 mmHg. On cardiac auscultation, a grade 4/6 systolic murmur was heard over the area of pulmonic valve. Electrocardiography showed low voltage. Chest radiography showed a normal cardiac configuration and no pulmonary abnormality was seen. Esophagogram and endoscopy showed a 10cm sized ulcerative and infiltrative esophageal cancer. This esophageal cancer was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography, MRI, coronary angiography, and endomyocardial biopsy were performed. The MRI, echocardiography and right ventriculography revealed a 7 cm sized lobulated mass extending to the right ventricular outflow tract, right ventricle, septum, and anterior wall of the left ventricle. Interestingly, the feeding vessels of the tumor were identified by echocardiography and coronary angiography. Histologically, the cardiac tumor was proven to be have the same pathologic findings as the an esophageal cancer, compatible with carcinomatous metastasis.