Asymptomatic Cardiac Metastases From Esophageal Cancer: A Case Report Of Ante-mortem Detection And Literature Review

Metastatic spread to the heart from neoplasms is very rare, often silent and rarely gains clinical attention. Usually, it correlates with widespread metastatic disease and is suggestive of a poor prognosis. Most cardiac metastases (CM) are detected following post-mortem studies with only a handful reported antemortemly. Here, we report a case of an asymptomatic cardiac metastasis from esophageal carcinoma and a review of the literature. In late July 2014, a 73-year-old woman diagnosed with locally advanced esophageal squamous cell carcinoma was admitted to our institution. Cardiothoracic metastases were not detected at basal computed tomography (CT) scan. The patient was submitted to concurrent cisplatin and radiotherapy. Just before surgery, a CT scan revealed two metastases in the right ventricle and in the interventricular septum. Transthoracic echocardiography and an endomyocardial biopsy confirmed the diagnosis of squamous cell carcinoma from the esophageal origin. In February 2015, chemotherapy was started, but after two courses of gemcitabine, a pulmonary embolism and then a congestive heart failure caused death of the patient on April 2015. Reviewing the literature, 14 cases with an antemortem diagnosis of CM from esophageal cancer were reported. Our patient should be the fifteenth case with an uncommon presentation without symptoms or signs in the diagnosis. Our case highlights that patients should be evaluated using echocardiography for CM, even if asymptomatic.