Asymptomatic melanoma of the superior cavo-atrial junction:
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
The incidence of primary melanomas has increased significantly. In autopsy studies, cardiac metastases are shown to be frequent in malignant melanoma (MM) patients. However, in vivo, the diagnosis is rarely established. Early stages are usually asymptomatic whereas the occurrence of hemodynamic symptoms often indicates inoperability. Follow-up in melanoma patients usually includes whole body computed tomography (CT) examination. In CT scans, however it may be difficult to identify small cardiac masses due to artifacts secondary to movement and contrast media inflow. In this report we compared different imaging modalities and describe the successful diagnosis and treatment of an asymptomatic metastasis of the right heart.

Case report
We report the case of a 41-year-old Caucasian with a metastasis in the superior vena cava (SVC). Five years prior to admission, the patient was diagnosed with MM of the left foot. He experienced a 2-year history of recurrent isolated metastases in the ipsilateral groin lymph nodes. Each time the tumors were excised successfully. During his follow-up the patient was asymptomatic and in excellent physical condition. In a whole body contrast-enhanced CT scan, a metastatic lymph node localized near the left common iliac artery was the only pathological finding. An additional 18F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) examination however, showed a high tracer uptake in the SVC close to the right atrium (RA) (Figure ?(Figure1C).1C). This lesion was not seen in the initial CT scanning due to artifacts caused by contrast media inflow, but suspected in a CT-scan of better quality. Magnetic resonance imaging.....