Cardiac metastasis of urothelial carcinoma mimicking ST-elevation myocardial infarction

Česká verzia

Authors: L. Chaloupková; V. Suchánek; T. Büchler
Authors place of work: Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic Department of Diagnostic Radiology, Second Faculty of Medicine
Published in the journal: Klin Onkol 2025; 38(6): 479-483
Category: Kazuistiky
doi: https://doi.org/10.48095/ccko2025479

Summary

Background: Urothelial carcinoma (UC) is the second most common malignancy of the urinary tract. While distant metastases are relatively frequent in advanced UC, cardiac involvement is exceedingly rare and typically asymptomatic. When present, it may mimic acute cardiovascular events, complicating timely diagnosis and management. Case: We describe the case of an 81-year-old man with a history of metabolic syndrome and stable cardiac disease, who was diagnosed with high-grade urothelial carcinoma of the renal pelvis with pulmonary metastases. Two months after nephroureterectomy and during first-line carboplatin chemotherapy, the patient presented with progressive dyspnoea. ECG showed ST-segment elevations suggestive of acute myocardial infarction, yet urgent coronary angiography and laboratory markers excluded acute coronary syndrome. Echocardiography and cardiac MRI revealed a large myocardial metastasis infiltrating the right ventricle and interventricular septum. Given the advanced stage and poor prognosis, active oncologic treatment was discontinued, and palliative care was initiated. Results: This case highlights a rare presentation of cardiac metastasis mimicking ST-elevation myocardial infarction in a patient with advanced urothelial carcinoma. Multimodal cardiac imaging was key to establishing the diagnosis. Despite its rarity, myocardial infiltration should be considered in oncologic patients presenting with cardiac symptoms and ECG abnormalities. Conclusion: Cardiac metastases from urothelial carcinoma are rare but clinically significant, often associated with poor outcomes. ECG changes resembling myocardial infarction warrant thorough evaluation, particularly in patients with known malignancy. Early diagnosis, even in the absence of curative options, may help guide appropriate palliative care.

Keywords:

urothelial carcinoma – neoplasm metastasis – Electrocardiography – multimodal imaging – heart neoplasms – myocardial infarction mimicry

Zdroje

1. SVOD. Portál epidemiologie novotvarů v ČR. [online]. Dostupné z: https: //www.svod.cz.

2. Giudici N, Bonne F, Blarer J et al. Characteristics of upper urinary tract urothelial carcinoma in the context of bladder cancer: a narrative review. Transl Androl Urol 2021; 10 (10): 4036–4050. doi: 10.21037/tau-20-1472.

3. Chen WK, Wu ZG, Xiao YB et al. Prognostic value of site--specific metastases and therapeutic roles of surgery and chemotherapy for patients with metastatic renal pelvis cancer: a SEER based study. Technol Cancer Res Treat 2021; 20 : 15330338211004914. doi: 10.1177/15330338211004914.

4. Bussani R, De-Giorgio F, Abbate A et al. Cardiac metastases. J Clin Pathol 2007; 60 (1): 27–34. doi: 10.1136/jcp.2005.035105.

5. Hanfling SM. Metastatic cancer to the heart. Review of the literature and report of 127 cases. Circulation 1960; 22 : 474–483. doi: 10.1161/01.cir.22.3.474.

6. Butany J, Leong SW, Carmichael K et al. A 30-year analysis of cardiac neoplasms at autopsy. Can J Cardiol 2005; 21 (8): 675–680.

7. Amano J, Nakayama J, Yoshimura Y et al. Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences. Gen Thorac Cardiovasc Surg 2013; 61 (8): 435–447. doi: 10.1007/s11748-013-0214-8.

8. Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol 2004; 15 (3): 375–381. doi: 10.1093/annonc/mdh086.

9. Brakenhielm E, González A, Díez J. Role of cardiac lymphatics in myocardial edema and fibrosis: JACC review topic of the week. J Am Coll Cardiol 2020; 76 (6): 735–744. doi: 10.1016/j.jacc.2020.05.076.

10. Hattori S, Miyajima A, Maeda T et al. Metastatic urothelial carcinoma to pericardia manifested by dyspnea from cardiac tamponade during systemic chemotherapy: case report and literature review. Can Urol Assoc J 2012; 6 (5): E184–E188. doi: 10.5489/cuaj.11130.