Left Anterior Descending Coronary Artery Occlusion Secondary to Metastatic Squamous Cell Carcinoma Presenting as ST-Segment–Elevation Myocardial Infarction
A 52-year-old woman presented to the emergency department with intermittent dull substernal chest pain over the past 2 months that had become constant and severe over the past day. Six months before presentation, she had been diagnosed with squamous cell carcinoma of the tongue for which hemiglossectomy and radical neck dissection was performed. Two months before presentation, 18-fluorodeoxyglucose positron emission tomography detected hypermetabolic foci in the lungs that were proven on biopsy to be metastatic lesions. On retrospective review of the scan, a nonspecific hypermetabolic focus was noted in the septal myocardium [Figure (A)].
In the emergency department, her ECG showed an evolving anterior ST-segment–elevation myocardial infarction [Figure (B)]. She was taken to the cardiac catheterization laboratory where emergent coronary angiography was performed. This showed an abrupt termination of the distal left anterior descending coronary artery [Figure (C) and Movie I in the online-only Data Supplement]. The vessel appeared to have an abnormal epicardial course with an inward curve into the myocardium, possibly suggesting an overlying mass lesion …