부산대학교 도서관

A 65 year-old man was observed for weight loss and skin nodules. Skin biopsy allowed to make diagnosis of cell epidermoid melanoma. In the staging CT, there was pericardial effusion and the presence of a solid formation of irregular shape in the right sections of the heart (Figure 1). The transthoracic echocardiogram shows initial compression of the right chambers (Figure 2); an evacuative pericardiocentesis was performed; the bacterial culture was negative as the detection of neoplastic cells. Post-pericardiocentesis echocardiogram defined the inhomogeneous mass which infiltrates the right ventricular free wall, into the right atrium and involving the lateral border of the tricuspid valve, without outflow obstruction (Figure 3). During hospitalization, the patient remained in quite good hemodynamic compensation. Given the spread of melanoma, it was decided to implement only palliative therapy. Cardiac metastasis are up to 20% in autopsy cases (about 50 % in melanomas). Metastases may reach the heart by contiguity or through the lymphatic and hematogenous dissemination. Pericardium is commonly involved with the production of effusion, the endocardium and myocardium are more rare localizations. Due to subtle clinical manifestations metastases often in staging procedures are not searched carefully for the definition of patient prognosis and therapy. Our patient demonstrates the rare possibility of tumor localization with endocardial right ventricular commitment with few symptoms. It remains of uncertain interpretation the negative result of the pericardial fluid cytological examination. We believe that the use of systematic search techniques based on appropriate cardiac imaging is a useful adjunct in the staging of malignant tumors very aggressive. Figure