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S-145￭
A case of cardiac metastasis to left atrium from small cell lung carcinoma
가톨릭대학교 성빈센트병원 순환기내과
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장보현, 김지희, 김철민
Secondary cardiac tumors are much more common than primary tumors of the heart. In lung cancer, rates of heart invasion were shown to differ on the basis of the pathologic type. Adenocarcinoma spread to the heart in 26% of cases, squamous cell carcinoma in 23.4%, undifferentiated carcinoma in 21.2% and bronchoalveolar carcinoma in 17.4%. For all the lung cancer pathologic type, the most involved area of spreading was the pericardium. In the previous study, 24% patients with small cell lung carcinoma (SCLCa) had cardiac involvement and then, the pericardium was involved in all cases.
In retrospective study of extensive disease SCLCabetween 1999 and 2010, about 29% patients had pleural and/or pericardial metastasis. However, there was no intracardiac metastasis in extensive disease SCLCa. To our knowledge, there has been no report of metastasis of small cell lung carcinoma to the heart. Here, we report a case of SCLCa with symptomatic metastases invading the left atrium via right inferior pulmonary vein (Figure).
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S-146￭
A case of myocardial ischemia due to progression of myocardial bridging
Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Kyung Up Kim, Jae Kyun Choi, Hye Mi Oh, Ji Young Woo, Hee Su Park, Soo Yoon Moon, Kyoo Rok Han
Although myocardial bridging is generally considered benign, it has been associated with myocardial ischemia. A recent analysis of intracoronary ultra- sonography showed relaxation of coronary artery is delayed during early diastole in a coronary vessel with myocardial bridging, which can decrease the coronary vasodilator reserve. Furthermore, progression of left ventricular hypertrophy, increased myocardial contractility and tachycardia can make the tunneled segment deeper and systolic compression aggravated. However, there are few reports on the progression of myocardial bridging, which is also related to the myocardial ischemia. We report a case in which progression of myocardial bridging in the mid-left anterior descending artery (LAD) was demonstrated by coronary angiography and caused myocardial ischemia. A 70-year-old man visited the hospital with worsening chestpain. His previous coronary angiography showed myocardial bridging at the mid LAD with 50% luminal narrowing during systole in 2006 (Fig. 1A). His blood pressure was not well controlled because of poor compliance. Follow-up coronary angiography showed myocardial bridging at the mid LAD progressed to se- vere stenosis (＞90% luminal narrowing during systole) and total length of the tunneled artery extended from 22.5 mm to 23.9 mm (Fig. 1C). After blood pressure was controlled, his chest pain was relieved. This is the first report of myocardial ischemia secondary to progression of myocardial bridg- ing caused by sustained hypertension in Korea, which was proved by coronary angiography.
