Image| Volume 23, ISSUE 3, e107-e108, March 2014

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Nodular Pericardial Metastases

Published:October 28, 2013DOI:
      A 50 year-old male with a 60 pack-year smoking history presented with worsening left upper back pain. He also complained of increasing shortness of breath, difficulty in swallowing, and unintentional 40-pound weight loss over the past four months. Chest computed tomography revealed a large left lower lobe mass (asterisk in Fig. 1A) and numerous soft tissue nodules along the pericardium (arrows in Fig. 1A and B). Echocardiogram also revealed echogenic pericardial nodules (Fig. 1C). Findings were most suggestive of primary bronchogenic malignancy with pericardial metastases. Subsequent biopsy of the left lower lobe mass revealed invasive squamous cell carcinoma. Abdominal magnetic resonance imaging done later for other reasons also demonstrated the enhancing nodules along the pericardium (Fig. 1D).
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      Fig. 1Nodular pericardial metastases from primary bronchogenic malignancy. (A and B) Contrast-enhanced computed tomography with axial (A) and sagittal reformation (B) reveals numerous soft tissue nodules, compatible with metastases, along the pericardium (arrows). Asterisk in (A) denotes the primary bronchogenic malignancy. (C) Apical transthoracic echocardiogram demonstrates echogenic pericardial nodules (arrows). D. Contrast-enhanced magnetic resonance imaging also shows the bulky enhancing pericardial nodules (arrows).
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