Right ventricular mass in a 10-year-old girl with osteosarcoma: an unusual case of asymptomatic cardiac metastasis
Year: 2024
Type: article
Study design: Case Report
Abstract: Clinical noteDuring routine surveillance imaging of a 10-year-old girl with osteosarcoma, a right ventricular filling defect was identified on contrast-enhanced chest computed tomography (CT).Sixteen months earlier, she was diagnosed with osteosarcoma of left distal femur, with lung metastasis.Response to chemotherapy was poor.After limb salvage surgery, chemotherapy was changed, followed by bilateral wedge resection of lungs.However, she developed another lung metastasis one month later.Despite switching chemotherapy, she experienced left buttock pain.Magnetic resonance imaging (MRI) revealed lumbar spine metastasis.Radiation therapy and extradural tumor excision provided temporary pain relief.Chemotherapy was changed, however, her tumor rapidly progressed to involve thoracic spine, and left femur.She showed no respiratory or cardiac symptoms, and vital signs were normal.Physical examination revealed no signs of heart murmur, lower limb swelling, or hepatome galy.Contrast-enhanced chest CT revealed multiple no dules, along with an unexpected filling defect in right ventricle (Fig. 1).The pulmonary artery and inferior vena cava were patent.Echocardiography demonstrated an irre gular surfaced mass measuring 4.1 cm×1.8 cm in the right ventricle occupying right ventricular outflow tract (Fig. 2).Right ventricle was slightly dilated with suspici ous dysfunction.Trivial tricuspid regurgitation and mild pulmonary hypertension (right ventricular systolic pres sure, 40 mmHg) were observed.Left ventricular size and contractility were normal.Laboratory findings were as follows: prothrombin time, 13.6 seconds (international nor malized ratio, 1.06); activated partial thromboplastin time 33.4 seconds; fibrinogen, 391 mg/dL (reference rage, 200-400 mg/dL); and D-dimer, 1.85 μg/ mL (reference rage, 0-0.39 μg/mL).She had central line (chemoport), however, considering the mass location and her advanced disease status, right ventricular mass was presumed to be a metastatic tumor.After discussing her grave condition, the parents opted for palliative care.She remained relatively well, however, she complained of chest tightness and pain 6 weeks later.Chest radiography revealed bilateral pleural effusions.She succumbed to progressive respiratory distress 4 days later.The present study was approved by the Institutional Re-
Source: Korean Journal of Pediatrics
Authors: Jun Ah Lee, Hyun-Ju Lim, Jong Woong Park, Sang-Hoon Shin, Mi Hyang Kwak
Institutions: National Cancer Center, National Cancer Center Hospital
Language: English
Topic: Cardiac tumors and thrombi
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4404729276