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Lung Cancer |

Left Atrial Invasion by Lung Mass Presenting as Embolic Stroke Diagnosed by Transesophageal Endobronchial Ultrasound (TE-EBUS) FREE TO VIEW

Haroon Raja, MD; Wissam Abouzgheib, MD; Ziad Boujaoude, MD; Abhishek Agarwal, MD; Rohan Arya, MD
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Cooper University Hospital, Cherry Hill, NJ


Chest. 2015;148(4_MeetingAbstracts):528A. doi:10.1378/chest.2273230
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Abstract

SESSION TITLE: Lung Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Cardio-embolic stroke is a rare initial presentation of a locally advanced lung cancer (1). We present a case of a neoplastic left atrial (LA) invasion by a right lower lobe (RLL) lung mass presenting as embolic stroke, which was diagnosed by TE-EBUS.

CASE PRESENTATION: A 57 year old female with a heavy smoking history and severe COPD presented to the ED with right sided weakness, dysarthria and worsening dyspnea. Magnetic resonance imaging (MRI) of the brain showed multiple acute non-hemorrhagic infarcts consistent with embolic stroke. Transthoracic echo (TTE) showed an echo density in the LA that was read as artifact. Computed tomography (CT) of the chest displayed a 5.8 cm RLL mass with direct invasion into the LA and right hilar and mediastinal lymphadenopathy (fig. 1). TE-EBUS guided transbronchial needle aspiration (TBNA) was performed considering her tenuous respiratory status. TE-EBUS guided TBNA confirmed direct invasion of the RLL mass into the LA, which was clinically consistent with her presentation of embolic stroke (fig. 2). The patient tolerated the procedure well without any immediate post-procedural complications.

DISCUSSION: This case is unique for multiple reasons. It describes a rare initial presentation of stroke in a patient with locally advanced lung cancer with direct invasion of LA. Such an uncommon manifestation has only been described in three previous case reports (1,2). This case also describes a situation in which TE-EBUS is superior to TTE in detecting cardiac chamber invasion by neighboring lung cancer. The invasion of the RLL mass into the LA was not well visualized on TTE but was clearly captured by the TE-EBUS, including the extension of the mass into the LA. The TE-EBUS was instrumental in determining the etiology of her stroke. Utilizing the esophageal route allowed this high risk patient, given her underlying comorbidities, to tolerate the procedure with decreased sedation requirements and minimal hemodynamic fluctuations.

CONCLUSIONS: TE-EBUS is a useful and safe modality in the diagnosis of locally invasive lung cancer with proximity to cardiac chambers.

Reference #1: Ascione L , et al. Ultrasonography in embolic stroke: the complementary role of transthoracic and transesophageal echocardiography in a case of systemic embolism by tumor invasion of the pulmonary veins in a patient with unknown malignancy involving the lung. Eur J Echocardiogr. 2004 Aug;5(4):304-7

Reference #2: Cetinkaya E, et al. Left atrial mass demonstrated during endobronchial ultrasound session. Respiration 2011;81:57-8.

DISCLOSURE: The following authors have nothing to disclose: Haroon Raja, Wissam Abouzgheib, Ziad Boujaoude, Abhishek Agarwal, Rohan Arya

No Product/Research Disclosure Information


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