Acute myocardial infarction caused by tumor embolus originating from upper tract urothelial carcinoma: a case report
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Acute myocardial infarction caused by tumor embolus originating from upper tract urothelial carcinoma: a case report Taku Yasui1, Yohei Okuda2, Wataru Shioyama1, Toru Oka1, Tatsuya Nishikawa1, Risa Kamada1, Koji Hatano2, Kazuo Nishimura2 and Masashi Fujita1*
Abstract Coronary emboli from malignant tumors rarely cause acute myocardial infarction. We report the case of a patient with tumor embolism from an upper tract urothelial carcinoma that caused acute myocardial infarction via a patent foramen ovale. Coronary blood flow was restored by embolus aspiration without stenting. Clinicians must consider malignant tumor embolism as a possible cause of acute myocardial infarction. Keywords: Paradoxical embolism, Patent foramen ovale, Neoplasm, Aspiration, Coronary occlusion
Introduction Tumor embolus is rare cause of acute myocardial infarction (AMI). Lung carcinoma was the most common source of coronary malignant tumor emboli, which was caused by direct tumor invasion to pulmonary veins and left atrium [1]. Here, we describe AMI caused by tumor embolus in a patient with upper tract urothelial carcinoma (UTUC). Case presentation A 62-year-old man diagnosed with UTUC and paraaortic lymph node metastasis (T4N2M0) was admitted to our hospital 2 h after sudden onset of severe chest pain after 2 cycles of chemotherapy with cisplatin and gemcitabine. On admission, his blood pressure was 120/81 mmHg, heart rate was 88 beats/min, respiratory rate was 20 breaths/min, and oxygen saturation was 96% on room air. He had no history of cardiovascular disease and no conventional coronary risk factors, including hypertension, diabetes mellitus, dyslipidemia, and cigarette * Correspondence: [email protected] 1 Department of Onco-Cardiology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan Full list of author information is available at the end of the article
smoking. Investigations performed at the time of admission revealed the following: creatine kinase (45 U/L; normal range, 59–248 U/L), creatine kinase-MB (1.0 ng/mL; normal range, < 5 ng/mL), and no elevated levels of cardiac troponin I (0.023 ng/mL; normal range, ≤0.026 ng/ mL). The D-dimer level was elevated (3.6 μg/mL; normal range, 0–1.0 μg/mL). Contrast-enhanced computed tomography (CT) showed no pulmonary embolism and no aortic dissection. A 12-lead electrocardiography showed hyperacute T waves in V2–4 leads (Fig. 1). Transthoracic echocardiography showed akinesis of the left ventricular anteroseptal-apical wall. He was diagnosed with AMI and emergency coronary angiography (CAG) was performed. CAG revealed emboli straddling the bifurcation between the left anterior descending artery and diagonal artery (Fig. 2a). Aspiration was performed with a Thrombuster II catheter (KANEKA Medix Corporation, Osaka, Japan) retrieving a substantial amount of organized material, after which Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow was achieved (Fig. 2b). An intravascular ultrasound revealed no evidence
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