山田 博胤¹, 大木 崇¹, 井内 新¹, 田畑 智継¹, 真鍋 和代¹, 福田 和代¹, 佐々木 美和¹, 福田 信夫², 伊東 進¹

Hirotsugu YAMADA¹, Takashi OKI¹, Arata IUCHI¹, Tomotsugu TABATA¹, Kazuyo MANABE¹, Kazuyo FUKUDA¹, Miwa SASAKI¹, Nobuo FUKUDA², Susumu ITO¹

¹徳島大学第2内科, ²国立善通寺病院

¹Second Department of Internal Medicine Tokushima University School of Medicine, ²Zentsuji National Hospital

キーワード : Cardiac metastasis, Malignant melanoma, Transesophageal echocardiography

A 42-year-old woman with systemic dissemination of malignant melanoma that had originated in the left toe was admitted to the hospital with complaints of precordial discomfort and abdominal fullness. Computed tomographic and serial echocardiographic studies suggested a diagnosis of intracardiac metastasis of malignant melanoma. The transthoracic echocardiogram showed a solid mass in the right ventricular cavity, and a huge immobile mass occupied almost the entire right ventricular cavity in the transesophageal echocardiogram. Furthermore, a mobile mass attached to the tricuspid valve appeared in the right atrial cavity at systole, and the mass echo prolapsed into the right ventricular cavity during diastole. Obstruction of the right ventricular inflow tract was also observed by two-dimensional and transthoracic continuous-wave Doppler echocardiography. The patient underwent partial resection of the tumor, which was identified histologically as a malignant melanoma with thrombi. This case indicates that transesophageal echocardiography can provide important information regarding hemodynamic and structural abnormalities of intracardiac metastatic malignant melanoma.