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Table of Contents
LETTER TO EDITOR  
Year : 2013  |  Volume : 16  |  Issue : 2  |  Page : 158-160
An unusual case of high central venous pressure


1 Department of Anesthesiology, Critical Care and Pain Medicine, University of Parma, Parma, Italy
2 Cardiac Surgery Intensive Care Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
3 Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy

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Date of Web Publication29-Mar-2013
 

How to cite this article:
Zasa M, Vezzani A, Aldrovandi A. An unusual case of high central venous pressure. Ann Card Anaesth 2013;16:158-60

How to cite this URL:
Zasa M, Vezzani A, Aldrovandi A. An unusual case of high central venous pressure. Ann Card Anaesth [serial online] 2013 [cited 2019 Sep 22];16:158-60. Available from: http://www.annals.in/text.asp?2013/16/2/158/109781


The Editor,

We describe the case of a 50-year-old male suffering from cirrhosis due to alcoholic hepatitis; the patient was admitted to hospital because of generalized deterioration. On admission, the patient was hypotensive (systolic arterial pressure 80 mmHg), stuporous and unable to report symptoms. However, distended neck veins were noticed and a physical examination revealed the presence of ascites. Since no peripheral access was accessible, a central venous catheter was inserted to rehydrate the patient, to administer intravenous therapy and to monitor the central venous pressure (CVP). A chest X-ray was then performed to check the placement of the catheter, which showed no abnormal findings. However, a CVP P value of 27 mmHg was noticed and a normal CVP waveform was detected, with "a" and "v" wave clearly represented. A transthoracic echography was then carried out, revealing presence of a mass in the right ventricle [Figure 1] and [Figure 2]. The right ventricle was enlarged and occupied by an echogenic mass. The mass appeared tightly attached to the right ventricular wall and to the tricuspid valve, causing prolapse of the tricuspid septal leaflet.
Figure 1: Parasternal short axis view. Metastasis occupying the right ventricle (RV = Right Ventricle; Mts = Metastasis)

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Figure 2: Subcostal view. Septal leaflet prolapse of the tricuspid valve (RA=Right Atrium; MTS = Metastasis; TV = Tricuspid Valve)

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Five years earlier the patient had undergone colon surgery because of cancer. Therefore, we assumed that the patient had suffered from a hematogenous spread of the colorectal cancer. Despite all medical efforts, the patient died 10 days later because of liver insufficiency. The autopsy confirmed the presence of a massive metastasis in the right ventricle, originating from an intestinal adenocarcinoma.

Cardiac tumors are a rare occurrence in clinical practice. Cardiac malignancies are encountered in about 1.23% of post mortem series, compared with 0.02-0.056% of primary cardiac tumors. [1] One-fifth of all patients with metastatic cancer are affected by cardiac metastases; [1],[2] lung carcinoma represents the most common primary tumor, while melanoma is the neoplasm with the greatest rate of cardiac involvement (50% of patients). [1],[3],[4]

Cardiac malignancies take their course so fast that patients are often asymptomatic. [1],[5] When present, most common signs and symptoms are heart failure, arrhythmias, cardiac tamponade, and embolisms. [1],[5] Metastatic tumors of the heart occur more often than primary ones; however, infiltration of the right heart by a metastatic colon cancer is not common. To our knowledge, only 11 cases have been reported in scientific literature. [4],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] The present case represents another evidence that colon malignancies may affect the right heart, so that a suspicion has to be held when treating patients with reported colon cancer who present with abnormal findings related to heart involvement.

 
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1.Ekmektzoglou KA, Samelis GF, Xanthos T. Heart and tumors: Location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. J Cardiovasc Med 2008;9:769-77.  Back to cited text no. 1
    
2.Sarjeant JM, Butany J, Cusimano RJ. Cancer of the heart: Epidemiology and management of primary tumors and metastases. Am J Cardiovasc Drugs 2003;3:407-21.  Back to cited text no. 2
    
3.Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol 2004;15:375-81.  Back to cited text no. 3
    
4.Choi PW, Kim CN, Chang SH, Chang WI, Kim CY, Choi HM. Cardiac metastasis from colorectal cancer: A case report. World J Gastroenterol 2009;15:2675-8.  Back to cited text no. 4
    
5.Debordeau P, Gligorov J, Teixeira L, Aletti M, Zammit C. Malignant cardiac tumors. Bull Cancer 2004;91 Suppl 3:136-46.  Back to cited text no. 5
    
6.Testempassi E, Takeuchi H, Fukuda Y, Harada J, Tada S. Cardiac metastasis of colon adenocarcinoma diagnosed by magnetic resonance imaging. Acta Cardiol 1994;49:191-6.  Back to cited text no. 6
    
7.Nishida H, Grooters RK, Coster D, Soltanzadeh H, Thieman KC. Metastatic right atrial tumor in colon cancer with superior vena cava syndrome and tricuspid obstruction. Heart Vessels 1991;6:125-7.  Back to cited text no. 7
    
8.Oneglia C, Negri A, Bonora-Ottoni D, Gambarotti M, Bisleri G, Rusconi C, et al. Congestive heart failure secondary to right ventricular metastasis of colon cancer. A case report and review of the literature. Ital Heart J 2005;6:778-81.  Back to cited text no. 8
    
9.Puvaneswary M, Thomson D, Bellamy GR. Cardiac metastasis from carcinoid tumor: Magnetic resonance imaging findings. Australas Radiol 2004;48:383-7.  Back to cited text no. 9
    
10.Makhija Z, Deshpande R, Desai J. Unusual tumours of the heart: Diagnostic and prognostic implications. J Cardiothorac Surg 2009;4:4.  Back to cited text no. 10
    
11.Zipoli A, Bartoli P, Fradella G, Sansoni M, Brandinelli A, Mazza F, et al. Right atrial metastasis as an initial clinical manifestation of adenocarcinoma of the colon. Ann Ital Med Int 1994;9:150-2.  Back to cited text no. 11
    
12.Teixeira H, Timoteo T, Marcao I. Cardiac metastases from a colonic tumor. Acta Med Port 1997;10:331-4.  Back to cited text no. 12
    
13.Choufani EB, Lazar HL, Hartshorn KL. Two unusual sites of colon cancer metastases and a rare thyroid lymphoma. Case 2. Chemotherapy-responsive right atrial metastasis from colon carcinoma. J Clin Oncol 2001;19:3574-5.  Back to cited text no. 13
    
14.Koizumi J, Agematsu K, Ohkado A, Shiikawa A, Uchida T. Solitary cardiac metastasis of rectal adenocarcinoma. Jpn J Thorac Cardiovasc Surg 2003;51:330-2.  Back to cited text no. 14
    
15.Patel SA, Herfel BM, Nolan MA. Metastatic colon cancer involving the right atrium. Tex Heart Inst J 2012;39:79-83.  Back to cited text no. 15
    

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Correspondence Address:
Michele Zasa
Department of Anesthesiology, Critical Care and Pain Medicine, University of Parma, Via Gramsci 14, 43100, Parma
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.109781

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