Metastatic Malignant Melanoma to the Heart
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⇓).
- Copyright © 1996 by American Heart Association