Image in medicine
Syncope: Arrhythmic onset of a metastasis
Síncope: debut arrítmico de una metástasis
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Perea, Rut Andrea" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Bàrbara" "apellidos" => "Carbonell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Margarida" "apellidos" => "Pujol-López" "email" => array:1 [ 0 => "mapujol@clinic.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Rodolfo" "apellidos" => "San Antonio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Sara" "apellidos" => "Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Rosario J." "apellidos" => "Perea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Rut" "apellidos" => "Andrea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiology Department, Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síncope: debut arrítmico de una metástasis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1137 "Ancho" => 1872 "Tamanyo" => 271865 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old man was admitted with a syncope. He had a lung adenocarcinoma 5 years ago treated with surgery, chemotherapy and radiotherapy. During monitoring he presented events of non-sustained ventricular tachycardia (VT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and sustained monomorphic VT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) controlled with esmolol.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Apical three-chamber view from transthoracic echocardiography, revealed a mass that could be either a thrombus or a tumor with an hyperdense peripheral border (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Coronary computed tomography angiography demonstrated an hyperdense peripheral apical zone with irregular borders (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D, <span class="elsevierStyleItalic">arrows</span>) and a central hypodense region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D, <span class="elsevierStyleItalic">asterisk</span>), suggesting a metastatic infiltration associated with thrombus formation respectively. It also revealed a pulmonary nodule at the left lower lobe and ruled out coronary artery disease.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cardiac magnetic resonance confirmed myocardium infiltration by a tumor in the cardiac apex. First-pass perfusion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E) and late enhancement sequences (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F) revealed an apical thrombus (<span class="elsevierStyleItalic">asterisk</span>) with surrounding metastatic infiltration (<span class="elsevierStyleItalic">arrows</span>). A posterior cytology of pericardial fluid confirmed the presence of adenocarcinoma cells.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main cause of VT is myocardial scarring from a previous infarction. The myocardium is the third-most common (30%) site of cardiac metastases (preceded by pericardium and epicardium); first clinical manifestation as a VT is unusual.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1137 "Ancho" => 1872 "Tamanyo" => 271865 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015200000012/v1_201906070610/S0025775318305268/v1_201906070610/en/main.assets" "Apartado" => array:4 [ "identificador" => "64289" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes médicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015200000012/v1_201906070610/S0025775318305268/v1_201906070610/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318305268?idApp=UINPBA00004N" ]
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