Procedure:
The patient underwent emergent cardiac catheterization, showing similar
findings as the last angiogram; however, due to persistent chest pain,
revascularization of the RCA with two drug-eluting stents (Figures 4 A -
E) was done. He had persistent symptoms despite revascularization. A
transthoracic echocardiogram (TTE) revealed reduced LVEF at 38% and a
mass compressing the right ventricular apex (Figures 5 A - C). A cardiac
magnetic resonance imaging (MRI) showed a large fungating invading mass
on the superior left upper lung field near the bifurcation of the
pulmonary artery (Figures 6 A & B). This mass had originated outside
the pericardium, infiltrating the surrounding structures, including the
superior aspect of the right ventricle, pulmonary artery, and
mediastinal tissue. A chest Computed Tomography (CT) demonstrated a
large invasive anterior mediastinal mass measuring 10.5 x 8.4 x 6.9 cm,
consistent with MRI. (Figure 7). CT-guided biopsy finally revealed
malignant SCC. A positron emission tomography scan and brain MRI
revealed metastases to the brain and adjacent lymph nodes (Figures 8 A -
D). Chemotherapy was not tolerated well due to severe axonal neuropathy.
Following an extensive discussion about the prognosis, the family and
the patient opted for hospice care.