Circulation. 1996;93:1066
(Circulation. 1996;93:1066.)
© 1996 American Heart Association, Inc.
Metastatic Malignant Melanoma to the Heart
William E. Katz, MD;
Peter F. Ferson, MD;
Robert E. Lee, MD;
William A. Killinger, MD;
Mark E. Thompson, MD;
John Gorcsan, III, MD
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Introduction
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 Top
 Introduction
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A 59-year-old man with widely metastatic malignant
melanoma
presented with complaints of chest pain, orthopnea,
and dyspnea.
He had a pulsus paradoxus of 35 mm Hg, jugular venous
distension,
and peripheral edema.
Echocardiography revealed a large
pericardial
effusion with signs of tamponade and dense echogenic masses
on
the epicardium (Fig 1
). Right heart
catheterization confirmed
tamponade physiology, and
percutaneous pericardiocentesis yielded
1 L
serosanguinous fluid. Cytology demonstrated atypical pigmented
cells
consistent with melanoma (Fig 2
). A pigtail
catheter drained
an additional 1 L fluid over the next 3 days;
therefore, the
patient was taken to the operating room for a
pericardial window.
After removal of the pericardial fluid, extensive
melanoma on
the epicardial surface of the heart could be visualized
with
a fiber-optic thoracoscopic videocamera (Fig 3
).
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Figure 1. Transthoracic echocardiogram in the
apical four-chamber view. There is a large pericardial effusion
(PE) and multiple echo-dense masses on the epicardial surface of
the heart (arrows). RV indicates right ventricle; LV, left ventricle;
RA, right atrium; and LA, left atrium.
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Figure 2. Photomicrograph of cytological specimen obtained
from the percutaneous pericardiocentesis fluid that was
fixed in alcohol, embedded in paraffin, and stained with hematoxylin
and eosin. Numerous large, pigmented tumor cells containing granules of
melanin are present. Mesothelial cells and a fibrin clot are also
visible (magnification x60).
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Figure 3. Image of the heart obtained in the operating room
through a subxiphoid pericardial window with a fiber-optic
thoracoscopic videocamera. Extensive melanoma appears black on the
epicardial surface of the right ventricle. For size reference,
metallic suction catheter in foreground measures 1 cm in
diameter.
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