Trombo intracardiaco, presentación inusual del carcinoma metastásico con primario desconocido: reporte de un caso

Abstract

Right atrial thrombus with superior vena cava obstruction as the initial manifestation of metastatic carcinoma of unknown primary origin is not a frequent event. Evidence-based guidelines for the clinical management of patients with thrombus are still limited. We present an 82-year-old patient with a history of COPD, diabetes mellitus and an ex-smoker, who was admitted due to frequent syncope and limiting dyspnea. The echocardiographic study revealed a large mass in the right atrium at the entrance of the superior vena cava. Surgical resection of the same was performed, which turned out to be a thrombus, a lymph node in the anterior mediastinum was also resected, which was positive for metastatic undifferentiated large cell carcinoma. The primary lesion was not found in the studies carried out. The patient remains stable clinically with mild dyspnea four months after surgery. However, the prognosis for a patient with such a diagnosis is poor. In the operation of an obstructive intracardiac thrombus, the possibility of an adjacent paraneoplastic syndrome should be suspected, so it should be taken into account in clinical practice and a good collection of samples should be made in the surgical act for the anatomopathological study. Surgery, despite being risky, is an option in patients with an intracardiac mass with hemodynamic compromise