ADENOCARCINOMA OF THE LUNG WITH UNUSUAL I NVASION OF METASTASES INTO THE PERICARDIUM

A 62-year-old man presented with chest pain was admitted to the hospit al. Coronary artery disease and pulmonary emboli were ruled out. Chest X-ray showed a left upper lobe nodule; differential diagnosis include d a tumor and a scar. Computed tomography (CT) of the chest revealed a pericardial effusion. Serial echocardiograms, a second CT and Magneti c resonance imagin could not differentiate between pericardial adhesio ns resulting from pericarditis and a solid mass. Within two months, th e patient developed severe congestive heart failure and had an anterio r myocardial infarction despite having had normal coronary arteries on arteriogram 4 weeks previously. He died shortly thereafter. On autops y, the left upper lobe nodule was found to be an adenocarcinoma, atypi cally metastatic to the pericardium with involvement of the myocardium and the left anterior descending artery.