A rare presentation of lung carcinoma: Cardiac metastasis with left atrial involvement through the pulmonary veins

Lung cancers can extend along or grow through the pulmonary veins to invade the left atrium. A 51-year-old man, previously healthy, presented with left-sided chest pain, dry cough, and dyspnea of 2 months’ duration. The patient also had a history of weight loss and decreased appetite. On physical examination, he had tachycardia and tachypnea. Cardiac examination revealed normal heart sounds and no murmurs. Auscultation of the chest revealed diminished breath sounds in the left hemithorax. Chest radiography showed a left-sided massive pleural effusion. A computed tomography scan confirmed the radiographic findings with a mass extending along the pulmonary vein into the left atrium, suggestive of tumor thrombosis. Transthoracic and transesophageal echocardiographic examinations revealed a mass within the left atrium, measuring about 1.9×1.6 cm at its largest diameter. This case report has 2 primary justifications, considering the rarity and the poor outcome. (Iranian Heart Journal 2021; 22(4): 148-155).