Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intracardiac metastasis as the initial presentation of malignant neoplasm is very rare. We report here on a 64-year-old man with non-small cell lung cancer (NSCLC) initially presenting with intracardiac metastasis which was identified with 18-F fluorodeoxyglucose positron emission tomography (FDG PET). The patient was admitted with complaints of exertional dyspnea and vague chest discomfort that had developed a few weeks ago. Two-dimensional echocardiography revealed a heart mass attached to its akinetic wall in the right ventricular chamber. CT and MRI demonstrated a large tumor involving the epicardium and myocardium in the right ventricle, and there was a mass in the right lower lobe of the lung along with multiple lymphadenopathies. Cytologic examination of the percutaneous needle aspiration of a lymph node in the anterior mediastinum revealed malignant epithelial cell nests, and this was strongly suggestive of squamous cell carcinoma. Subsequent FDG PET confirmed that the intracardiac mass had an abnormally increased FDG uptake, and again this was strongly suggestive of malignancy. By systemically considering these imaging studies, we were able to diagnose the mass as intracardiac metastasis of NSCLC.
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PMID:Non-small cell lung cancer initially presenting with intracardiac metastasis. 1590 60

A 67-year-old woman who complained of pain and sensory disturbance in the right upper extremity was admitted. Her chest CT showed a mass lesion in the upper lobe of the right lung, indicating invasion to the chest wall. CT-guided tumor biopsy resulted in a diagnosis of squamous cell carcinoma, and FDG-PET scan suggested metastasis to the right supraclavicular lymph node. We diagnosed squamous cell lung cancer (T3N3M0 : stage IIIB) and started chemotherapy using carboplatin and vinorelbine combined with thoracic radiotherapy. At the end of 6th cycles of chemotherapy, exertional dyspnea and palpitations appeared, and she was readmitted. Repeated transthoracic echocardiography showed a deterioration of the thickening of the right ventricular wall. Magnetic resonance imaging and Ga-scintigraphy suggested a neoplastic lesion in the myocardium. Eventually, we diagnosed it as myocardial metastasis from non-small cell lung cancer. Shortly after the beginning of palliative radiotherapy to the myocardial lesion, repeated episodes of ventricular tachycardia emerged. We stopped radiotherapy and managed to control the ventricular tachycardia by initiating amiodarone. Though we administered erlotinib as a second line chemotherapy, the primary tumor and pericardial effusion progressed and pleural effusion appeared, so we discontinued erlotinib. Pericardiocentesis was carried out to improve her symptoms and cytological examination of effusion revealed class IV. Her performance status dropped off and we decided to continue best supportive care. Myocardial metastasis of lung cancer is rarely a clinical problem, but it might have a decisive influence on the patient's prognosis due to serious arrhythmia or some other complications. Therefore, there is a need to consider cardiac involvement in the course of lung cancer.
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PMID:[Case of squamous cell lung cancer with myocardial metastasis complicated with ventricular tachycardia]. 1982 87

A 28-year-old man complained of intermittent irritable dry cough for 2 months with occasional bloody sputum. Positron emission tomography-computed tomography (PET-CT) suggested multiple heterogeneous soft tissue masses in the inferior lobes of both lungs, with heterogeneous increases in 18F-FDG uptake. No metabolic disorders were found in the rest of the body. CT-guided percutaneous lung puncture and biopsy and immunohistochemical study confirmed pulmonary primitive neuroectodermal tumor (PNET). PNET is characterized by small round blue cells and positive CD99 expression. After six cycles of chemotherapy with ifosfamide, dacarbazine and cisplatin, the lesions diminished substantially. At 2 months after the last cycle of chemotherapy, the patient complained of exertional dyspnea. PET-CT and echocardiogram suggested a space-occupying lesion in the right atrium. Autopsy revealed that this space-occupying lesion had the same pathomorphology and immunophenotype with pulmonary PNET, suggesting metastasis of pulmonary PNET to the right atrium. Here, we reported this rare case of pulmonary PNET metastasizing, instead of direct infiltrating or extending, into the heart.
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PMID:Rare pulmonary primitive neuroectodermal tumor metastasizing to the right atrium: a case report. 2239 99

A 51-year-old woman with dyspnea on exertion, fever, pleural effusion, and pericardial thickening underwent F-FDG PET/CT, which revealed focal hypermetabolic lesions in the right lung and left breast. The histopathology of the lesions was compatible with infiltration of inflammatory cells. Blood eosinophil counts were elevated, and enzyme-linked immunoassays were positive for antibodies to several parasites. After antiparasite medication, blood eosinophil counts were normalized, and PET/CT demonstrated complete disappearance of abnormal FDG accumulation in the lung and breast.
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PMID:18F-FDG PET/CT in a case of parasite infection mimicking lung and breast malignancy. 2514 May 47

A 60-year-old woman with biopsy-proven cardiac sarcoidosis status post implantable cardioverter defibrillator placement presented with periodic dizziness and dyspnea on exertion. Myocardial perfusion scan demonstrated a moderate sized, fixed perfusion defect along the mid to proximal anteroseptal wall of the left ventricle, with better perfusion on stress images. FDG-PET/CT demonstrated corresponding focal FDG avidity of the mid to proximal anteroseptal wall, suggestive of active cardiac sarcoidosis. Because of severe side effects, mycophenolate mofetil was discontinued, and the patient received low-dose steroid therapy. At 7-month follow-up FDG PET/CT, there was increased FDG avidity in the same regions, indicating worsening cardiac sarcoidosis.
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PMID:Serial FDG-PET/CT Imaging in the Management of Cardiac Sarcoidosis. 2921 12

Pulmonary artery sarcomas (PAS's) are extremely rare malignant tumors that arise from the endothelial lining of the pulmonary arteries. On CT scans PAS's appear as intraluminal filling defects in the pulmonary arteries, mimicking pulmonary embolism (PE). Due to the similarities in radiographic features as well as in clinical presentation, PAS's are usually misdiagnosed as pulmonary embolism. Since PASs are F-18 FDG avid, F-18 FDG PET/CT scan is a useful imaging tool for differentiating between these two conditions, as shown in this case report. We report a case of a 60-year-old woman presented with a 6-month history of chest pain, dyspnea on exertion, non-productive cough and weight loss. The initial CT pulmonary artery angiography showed extensive intraluminal mass in the pulmonary trunk and left pulmonary artery, diagnosed as massive pulmonary embolism. Since there was no clinical improvement after anticoagulant therapy, CT pulmonary angiography was repeated, and with no change observed in the intraluminal filling defect in pulmonary trunk, the possibility of tumor was raised. For further evaluation of a possible malignancy, F-18 FDG PET/CT was performed. It showed increased FDG uptake, suspicious for an aggressive tumor, in the intraluminal lesion of the pulmonary trunk and along the wall of the left pulmonary artery. There was no extrathoracic abnormality seen on PET/CT scan. Histopathological finding after complete pulmonary artery resection showed high grade undifferentiated pleomorphic sarcoma. F-18 FDG PET/CT is a useful tool for differentiating between pulmonary embolism and malignant intraluminal mass, and at the same time it enables the proper staging of the malignancy. < p > < /p >.
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PMID:F-18 FDG PET/CT in pulmonary artery sarcoma: clinical vignette. 2944 47

A 63-year-old male presented with loss of appetite, subfebrile fever, swelling of the right hand and dyspnea on exertion for three months. Past medical history revealed methotrexate treatment of six months for rheumatoid arthritis. Chest radiography and computed tomography (CT) revealed diffuse miliary nodules. PET/CT scan demonstrated diffuse FDG uptake in both lungs, in the spleen, in the right hand, the mediastinal and the axillary lymph nodes. MR of the right hand showed inflammatory arthritis. Histopathology of the right hand tru-cut biopsy revealed degenerative changes. Culture of the hand biopsy tissue was positive for mycobacterium tuberculosis. PET/CT may determine the biopsy and the sampling sites for the early diagnosis of patients with suspected miliary tuberculosis where lesion identification on other modalities may be difficult or unfeasible. High sensitivity for inflammatory diseases makes PET/CT a useful diagnostic utility for enabling early diagnosis in miliary tuberculosis which is a diagnostic predicament.
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PMID:Diagnostic utility of PET/CT in a patient with miliary tuberculosis. 3118 79