Cardiac metastasis of a plasmacytoma with clinical manifestations of extensive pulmonary embolism causing right ventricular outflow tract obstruction

History and clinical findings: A 48-year-old man with advanced light-chain plasmacytoma was admitted because of severe dyspnoea and tachycardia. Physi cal examination revealed peripheral cyanosis and signs of right heart failu re. Investigations: The partial pressure of oxygen and CO2 in arterial blood we re both reduces (72 mm Hg and 33 mm Hg, respectively). Liver enzyme activit ies were increased, there was right heart enlargement radiologically and th e ECG showed low voltage and typical signs of right heart strain. Echocardi ography revealed cardiac metastases of the plasmacytoma with subtotal right ventricular outflow tract obstruction (RVOTO), without any signs of pulmon ary emboli. Treatment and course: Palliative radiotherapy to the heart reduced the intr acardiac tumor size and improved the patients' general condition. The signs of the RVOTO were markedly reduced in both the ECG and the echocardiogram. But after this initial improvement pneumonia developed, of which the patie nt died. Autopsy revealed radiation pneumonia with extensive fibrosis as th e immediate cause of death. Conclusion: In patients with advanced neoplasia cardiac metastasis should b e included in the differential diagnosis of dyspnoea, tachycardia or hypote nsion of uncertain etiology. Echocardiography is the diagnostic tool of cho ice.