Endomyocardial fibrosis masquerading as metastatic colorectal tumour; myocardial tissue characterization pivotal in guiding urgent surgical management

Endomyocardial fibrosis masquerading as metastatic colorectal tumour; myocardial tissue... A 74-year old African male was admitted for urgent hemicolectomy for a colonic malignancy with impending bowel obstruction. Electrocardiogram showed marked T-wave inversion laterally with early repolarization changes (Panel A), in the absence of cardiac symptoms. He had no family history of cardiomyopathy or sudden cardiac death. Echocardiography showed a left ventricle (LV) mass thought to be malignant infiltration or thrombus. Cardiovascular magnetic resonance imaging was requested to clarify the findings, in order to aid surgical decision making. Cardiovascular magnetic resonance showed marked thickening (27 mm) of the LV and right ventricular apex, apical cavity amputation, and akinetic apical LV segments (Panel B, Supplementary material online, Video S1). There was no oedema or fat infiltration. Laminar LV thrombus adjacent to the akinetic LV apical thickening was seen with early gadolinium sequences (Panel C). Normal first pass rest perfusion of the myocardium suggested absence of increased vascularity. Patchy late gadolinium enhancement was seen in the thickest portions of the LV suggestive of fibrosis (Panel D). Staging computed tomography showed no metastasis but confirmed calcification of the thrombus (Panel E). The features were most consistent with incidental endomyocardial fibrosis and very unlikely to be a cardiac malignancy. The decision to operate with a curative intent was made. He made a good recovery following hemicolectomy. Endomyocardial fibrosis is the most common restrictive cardiomyopathy worldwide particularly in Africa. It is usually identified at the end stage when prognosis is very poor. The diagnosis was incidental in our case but initially caused a diagnostic and management challenge. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Endomyocardial fibrosis masquerading as metastatic colorectal tumour; myocardial tissue characterization pivotal in guiding urgent surgical management

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Publisher
Oxford University Press
Copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
ISSN
0195-668X
eISSN
1522-9645
D.O.I.
10.1093/eurheartj/ehy242
Publisher site
See Article on Publisher Site

Abstract

A 74-year old African male was admitted for urgent hemicolectomy for a colonic malignancy with impending bowel obstruction. Electrocardiogram showed marked T-wave inversion laterally with early repolarization changes (Panel A), in the absence of cardiac symptoms. He had no family history of cardiomyopathy or sudden cardiac death. Echocardiography showed a left ventricle (LV) mass thought to be malignant infiltration or thrombus. Cardiovascular magnetic resonance imaging was requested to clarify the findings, in order to aid surgical decision making. Cardiovascular magnetic resonance showed marked thickening (27 mm) of the LV and right ventricular apex, apical cavity amputation, and akinetic apical LV segments (Panel B, Supplementary material online, Video S1). There was no oedema or fat infiltration. Laminar LV thrombus adjacent to the akinetic LV apical thickening was seen with early gadolinium sequences (Panel C). Normal first pass rest perfusion of the myocardium suggested absence of increased vascularity. Patchy late gadolinium enhancement was seen in the thickest portions of the LV suggestive of fibrosis (Panel D). Staging computed tomography showed no metastasis but confirmed calcification of the thrombus (Panel E). The features were most consistent with incidental endomyocardial fibrosis and very unlikely to be a cardiac malignancy. The decision to operate with a curative intent was made. He made a good recovery following hemicolectomy. Endomyocardial fibrosis is the most common restrictive cardiomyopathy worldwide particularly in Africa. It is usually identified at the end stage when prognosis is very poor. The diagnosis was incidental in our case but initially caused a diagnostic and management challenge. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

European Heart JournalOxford University Press

Published: Apr 18, 2018

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