Author + information
- Received June 25, 2012
- Accepted July 10, 2012
- Published online January 29, 2013.
- Lakshman Subrahmanyan, MD, MS⁎,
- Erik Stilp, MD⁎,
- Marcin Bujak, MD, PhD⁎,
- Daniel Cornfeld, MD† and
- Lissa Sugeng, MD, MPH⁎
A 71-year-old man with a history of hepatocellular carcinoma presented with chest pain. An exercise myocardial perfusion scan showed anterior and inferior ischemia, and angiography demonstrated a long tubular stenosis of the mid left anterior descending coronary artery, a large capillary network draining into the right ventricle (A, Online Video 1), and a high-grade proximal stenosis and saccular aneurysm of the right coronary artery (B). Three-dimensional transthoracic echocardiography demonstrated a large mass (C, arrows) in the right ventricle extending to the outflow tract without obstruction (C, arrowhead; Online Video 2). Cardiac magnetic resonance imaging, performed for pre-operative planning, showed infiltration of the intraventricular septum and encasement of the left anterior descending coronary artery (D, arrowhead), corresponding to the anterior perfusion defect and limiting surgical debulking. After right coronary artery bypass and resection of the mass, histopathology demonstrated a highly vascular tumor that stained densely with the hepatocellular carcinoma–specific antibody HepPar1 (E). The patient's primary tumor, resected 5 years previously, is shown (F). Hepatocellular carcinoma ventricular metastases are extremely rare. This is the first case to our knowledge to demonstrate left coronary compromise from this process. Ao = aorta; PA = pulmonary artery; RA = right atrium.
Dr. Sugeng reports relationships with Philips Healthcare, Siemens Healthcare, and TomTec Imaging Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 25, 2012.
- Accepted July 10, 2012.
- 2013 American College of Cardiology Foundation