Dyspnoea and Impaired Ventricular Filling Due to Infiltration of the Left Atrium with a Lung Adenocarcinoma

Case report

A 59-year-old patient without a history of heart failure complained of progressive dyspnoea of two weeks’ du- ration. The chest radiograph showed a large left-sided pleural effusion, but the symptoms did not improve af- ter drainage of 1700 ml fluid. Transthoracic echocardi- ography demonstrated an unclear left atrial mass. Transoesophageal echocardiography showed an elon- gated, free floating mass originating from the left lower lung vein. This mass reached up to the posterior mitral leaflet and partially obstructed ventricular diastolic filling (Figure 1A). Computer tomography confirmed a cen- trally located mass measuring 7 × 6 × 6 cm and infil- trating the left lower lung vein and left atrium (Figure 1B). After metastatic disease was ruled out via positron emission tomography and brain-magnetic resonance imaging, the patient was scheduled for surgery. In toto resection of the tumour bulk including left pneumec- tomy, partial resection of the left atrium and recon- struction of the atrium with xenopericard was per- formed under extracorporeal circulation (Figure 1C). His- topathological examination of the resected tissue showed a low-differentiated adenocarcinoma (Figure 1D). The patient was discharged 14 days postoperatively. At follow-up after 18 months the patient is free of dysp- noea and well.