A case of double cancers with myocardial metastasis mimicking acute myocardial infarction both on an electrocardiogram and on Tc-99m-MIBI myocardial SPECT

We report a rare case of double cancers with myocardial metastasis presenti ng acute myocardial infarction (AMI)-like findings both on an electrocardio gram (ECG) and on Tc-99m-MIBI myocardial SPECT. The ECG showed abnormal Q-w aves and ST-segment elevation in leads V-1-V-4, and Tc-99m-MIBI SPECT showe d a photon deficient area in the anteroseptum. These findings were suggesti ve of AMI, but the patient had been simultaneously suffering from two adeno carcinomas, which were lung cancer and gastric cancer, and consecutive ultr asonic cardiography (UCG) demonstrated a growing mass lesion in the septal aspect of the left ventricle. After a month he died of severe heart failure . The histological diagnosis of a specimen of the: cardiac mass lesion was invasive adenocarcinoma infiltrating to the heart, which revealed that the myocardial metastasis had mimicked AMI. This case shows that it is difficul t to distinguish between myocardial infarction and myocardial metastasis wi th myocardial perfusion SPECT. It is necessary to consider the possibility of myocardial metastasis when a patient with malignancy presents AMI-like f indings.