Coronary thrombus aspiration revealed tumorous embolism of myxofibrosarcoma from the left atrium
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CASE REPORT
Coronary thrombus aspiration revealed tumorous embolism of myxofibrosarcoma from the left atrium Masamitsu Noguchi • Yoko Yamada • Kenichi Sakakura • Takuji Katayama Shin-ichi Momomura • Junya Ako
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Received: 12 January 2015 / Accepted: 12 February 2015 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract Thrombus aspiration is currently the standard strategy for primary PCI. Thrombus can be aspirated via aspiration catheters, restoring coronary blood flow. However, there are a limited number of reports regarding thrombus aspiration toward tumor embolized occlusion. We present a case of 90-year-old male with AMI caused by the metastatic tumor embolism. Emergent coronary angiography revealed total occlusion in three epicardial vessels. Histopathological examination of the aspirated specimen revealed the mixture of thrombus and metastatic tumor cells. Thrombus aspiration was partially effective for restoring coronary blood flow; however, it was very helpful for the final diagnosis of tumor embolism.
because of the large amount of thrombi [3]. Furthermore, it is very difficult to differentiate tumor embolized occlusion from thrombus occlusion following intimal plaque rupture at the time of primary PCI. Thrombus aspiration is currently the standard strategy for primary PCI [4, 5]. Thrombus can be aspirated via thrombectomy catheters, restoring coronary blood flow [5]. However, there are a limited number of reports regarding thrombus aspiration toward tumor embolized occlusion. We present a case of 90-year-old male with AMI caused by the metastatic tumor embolism. Thrombus aspiration was partially effective for restoring coronary blood flow and was helpful for the definitive diagnosis of tumor embolism.
Keywords Acute myocardial infarction Tumor embolism Thrombus aspiration
Case report
Introduction Acute myocardial infarction (AMI) caused by coronary tumor embolism is rarely observed, but potentially lethal [1, 2]. Primary percutaneous coronary intervention (PCI) for AMI caused by tumor embolism can be complicated
M. Noguchi and Y. Yamada contributed equally to this article. M. Noguchi Y. Yamada K. Sakakura (&) T. Katayama S. Momomura J. Ako Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan e-mail: [email protected] J. Ako Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
A 90-year-old man was admitted to our hospital because of acute ST-elevation myocardial infarction (Killip Class III). He had a history of myxofibrosarcoma in the right upper arm. The electrocardiogram showed ST segment elevation in lead I, aVL, and V2 to V5 with reciprocal changes in lead II, III, and aVF (Fig. 1a). Initial creatine kinase (CK) and CK-MB were 1505 and 173 U/L, respectively, and Trop T test (TROP T sensitive, NIHON KOHDEN, Tokyo, Japan) was positive. The chest X-ray showed bilateral congestion and multiple round masses in the right lower lung field and left middle lung
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