Lung Cancer: Student/Resident Case Report Poster - Lung Cancer II |

Atrial Fibrillation as the Initial Presentation of Lung Cancer FREE TO VIEW

Ahmed Dirweesh, MD; Ritika Zijoo, MD
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Seton Hall University, St. Francis Medical Center, Hamilton, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):767A. doi:10.1016/j.chest.2016.08.862
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Metastases to the heart and pericardium can occur in 18% of patients with an underlying tumors. Such patients may develop arrhythmias, pericarditis, pericardial effusion and heart failure. We report a case of a lung cancer, invading the left atrium, resulting in pericardial effusion and presenting with atrial fibrillation.

CASE PRESENTATION: A 59-year-old male with PMH of COPD and tobacco abuse presented with complaints of new-onset palpitations and an unintentional weight loss of 20 lbs. in the last 3 months. He was found to have an irregular-irregular pulse (115/min). The rest of the examination was normal. EKG showed atrial fibrillation with a rapid ventricular rate and chest x-ray showed a left paraspinal mass with emphysematous changes. A CT scan chest showed a left hilar and posterior mediastinal mass occluding the left lower lobe bronchus, narrowing inferior pulmonary veins, with extrinsic mass effect on the left atrium. CT guided FNAc was indicative of squamous cell carcinoma of the lung. A 2D echocardiogram revealed pericardial effusion.

DISCUSSION: Lung cancer is the leading cause of cancer-related deaths in the US (27% of all cancer deaths). Squamous cell carcinoma, commonly seen in smokers, arise frequently in the proximal bronchi and tend to cause bronchial obstruction, atelectasis, pneumonia or pericardial effusions. Few cases have documented the occurrence of arrhythmia as the first manifestation of a tumor invading atrial structures. The most dramatic presentation is a sudden conduction abnormality with various degrees of heart block. Atrial fibrillation episodes are triggered by ectopic beats from fibers extending from the left atrium into the pulmonary veins. Tumor cells infiltrate the myocardium creating a pulmonary vein sleeve, which is interdigitated by smooth muscle and fibrous tissue, thus creating a chance for micro-reentry. Mediastinal tumors can also result in mechanical stretching of the pulmonary vein(s) and atrial fibers resulting in tachycardia. In our case enhanced CT revealed the presence of a lesion encircling/narrowing the inferior pulmonary veins. We propose that his presentation could be explained by a reentry, presence of pericardial effusion, and/or as a consequence of the compression of the heart by the growing tumor.

CONCLUSIONS: While arrhythmias can be a rare complication of lung tumors, it can rapidly result in hemodynamic instability if not recognized and treated promptly. Physicians are expected to look for lung tumors invading the heart when a patient with a significant smoking history presents with a new onset atrial fibrillation.

Reference #1: Mio Tamura, et al. A case of atrial tachycardia originating from pulmonary vein invaded by lung cancer. Journal of Cardiology Cases 2012; 5, 118—121

Reference #2: Parambil JG, Gersh BJ, Knight MZ, Krowka MJ, Ryu JH. Bronchogenic cyst causing atrial fibrillation by impinging the right inferior pulmonary vein. Am J Med Sci 2006;331:336—8

Reference #3: American Cancer Society/Cancer Facts and Figures 2015

DISCLOSURE: The following authors have nothing to disclose: Ahmed Dirweesh, Ritika Zijoo

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