His white blood count (12,400/µL) and high sensitive C-reactive protein (6.79

mg/dL) were elevated and chest X-ray showed multifocal pneumonic infiltration in both lung fields as well as a huge mass in the lower zone of the right lung. His brain CT showed the old cerebral infarction in the left medial-frontal area and the acute cerebral infarction in the right fronto-temporal area (Fig. 1). Transthoracic echocardiographic (TTE) examination was performed to investigate the cause Inhibitors,research,lifescience,medical of his recurrent cerebroembolic episodes, revealing a very huge, mobile mass in the LA which originated from the right main pulmonary venous trunk accompanied by a small amount of pericardial effusion (Fig. 2). The mass moved in a to-and-fro fashion through Inhibitors,research,lifescience,medical the mitral valve with neither

significant obstruction of the mitral inflow nor pressure gradient between the LA and left ventricle (LV). LV ejection fraction and LA size were MEK162 mechanism within normal range. In order to figure out the relation of the mass to the surrounding structures, chest CT was subsequently performed, showing multi-focal consolidation in both lung fields and a huge mass of 6.0 cm by 4.5 cm size in the right lower lobe encroaching the right main pulmonary artery, right pulmonary venous trunk and LA (Fig. 3). Intracardiac mass as well as lung mass were increased and multifocal metastasis and pneumonia in both lungs were aggravated compared to previous chest CT. http://www.selleckchem.com/products/Gefitinib.html metastatic lymphadenopathy Inhibitors,research,lifescience,medical at both paratracheal, lobar and interlobar station and malignant pleural effusion were also noted. Due to strong rejection of further work-up and treatment

Inhibitors,research,lifescience,medical by his family members, it was inevitable to select supportive treatment. A short-time later, he passed away. Fig. 1 Acute cerebral infarction is seen in the right fronto-temporal lobe (arrow) and the old one in left medial-frontal lobe (arrowhead). Fig. 2 Echocardiogram shows Inhibitors,research,lifescience,medical a large intracavitary globular and linear mass, occupying most of the left atrium (LA) cavity. The mass originated from the pulmonary vein (arrow), directly invaded through the pericardium and into the LA. LV: left ventricle, RA: … Fig. 3 A huge lung mass of 6.0 cm by 4.5 cm size (arrow) in the right lower lung zone AV-951 that invaded into the right main pulmonary artery, right pulmonary venous trunk and left atrium is seen. Discussion Excluding systemic tumor emboli caused by left atrial myxomas, tumor emboli large enough to cause symptomatic cerebral ischemia are quite rare. The sites of tumor emboli reported most frequently are the aortic bifurcation or femoral vessels (50%) and the cerebral circulation (30%).4),5) In the most cases, an advanced primary or metastatic pulmonary tumor gains access to the arterial system through the pulmonary veins.6),7) Lung cancer invades the heart in two different ways: direct invasion by a primary tumor or a metastatic lymph node, and tumor invasion contiguously through the pulmonary veins.