METASTATIC MELANOMA TO THE HEART - A CASE -REPORT WITH CARDIAC TAMPONNADE

Introduction. Melanoma is the most frequent cause of neoplastic metast asis to the heart. The diagnosis is however usually made after the pat ient's death as clinical signs are discrete, non-specific or masked by other visceral metastases. Case report. A 50-year-old man who was giv en chemotherapy for metastatic melanoma limited to the mediastinal lym ph nodes suddenly developed acute dyspnea due to cardiac tamponnade. P uncture biopsy of the pericardium revealed melanoma cells and nodular infiltration of the pericardium. A pleuro-pericardial window gave func tional relief. The patient died 5 months later due to a recurrent epis ode of cardiac tamponnade. Discussion. The diagnosis of metastasis to the heart of a malignant melanoma may be suspected in patients develop ing heart failure, rhythm or conduction disorders or pericardial effus ion. The diagnosis can usually be confirmed with transthoracic sonogra phy. Endocavitary or transmural tumors may require transesophageal ech ography or magnetic resonance imaging before surgery to determine exte nsion and myocardial infiltration. Despite the severe prognosis, in ca se of immediate life-threatening emergencies or isolated cardiac metas tases, a surgical treatment may be considered.