Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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 presenting acute myocardial infarction (AMI)-like findings both on an electrocardiogram (ECG) and on Tc-99m-MIBI myocardial SPECT. The ECG showed abnormal Q-waves and ST-segment elecvation in leads V1−V4, and Tc-99m-MIBI SPECT showed a photon deficient area in the anteroseptum. These findings were suggestive of AMI, but the patient had been simultaneously suffering from two adenocarcinomas, which were lung cancer and gastric cancer, and consecutive ultrasonic 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 difficult to distinguish between myocardial infarction and myocardial metastasis with myocardial perfusion SPECT. It is necessary to consider the possibility of myocardial metastasis when a patient with malignancy presents AMI-like findings.

This is a preview of subscription content, log in to check access.


  1. 1.

    Nakayama R, Kimura K. Cancer and the heart, with special reference to cardiac metastasis of malignant tumors.Gan No Rinsho 1966; 12: 599–609.

  2. 2.

    Abe S, Watanabe N, Ogura S, Kunikane H, Isobe H, Yamaguchi E, et al. Myocardial metastasis from primary lung cancer: myocardial infarction-like ECG changes and pathologic findings.Jpn J Med 1991; 30: 213–218.

  3. 3.

    Strauss BL, Matthews MJ, Cohen MH, Simon R, Tejada F. Cardiac metastases in lung cancer.Chest 1977; 71: 607–611.

  4. 4.

    Adenle AD, Edwards JE. Clinical and pathologic features of metastatic neoplasms of the pericardium.Chest 1982; 81: 166–169.

  5. 5.

    Skhvatsabaja LV. Secondary malignant lesions of the heart and pericardium in neoplastic disease.Oncology 1986; 43: 103–106.

  6. 6.

    Tamura A, Matsubara O, Yoshimura N, Kasuga T, Akagawa S, Aoki N. Cardiac metastasis of lung cancer. A study of metastatic pathways and clinical manifestations.Cancer 1992; 70: 437–442.

  7. 7.

    Nezuo S, Tohara M, Katsume H, Arakawa M, Sawayama T, Koresawa S, et al. Metastatic cardiac tumor (Original title in Japanese).Naika 1974; 34: 312–316.

  8. 8.

    Okada S, Kawanishi K, Ofuji T. A case of metastatic cardiac tumor (Original title in Japanese).Shinzo 1972; 4: 74–79.

  9. 9.

    Mikasa K, Katada H, Ito S, Yoneda N, Sawaki M, Mikami R, et al. Transmyocardial metastasis of a lung cancer showing a recent myocardial infarction-like ECG: Report of a case with autopsy findings.Haigan 1985; 25: 93–98.

  10. 10.

    Rosenbaum FF, Johnston FD, Alzamora VV. Persistent displacement of the RS-T segment in a case of metastatic tumor of the heart.Am Heart J 1944; 27: 667–675.

  11. 11.

    Harris TR, Copeland GD, Brody DA. Progressive injury current with metastatic tumor of the heart.Am Heart J 1965; 69: 392–400.

  12. 12.

    Koiwaya Y, Nakamura M, Yamamoto K. Progressive ECG alterations in metastatic cardiac mural tumor.Am Heart J 1983; 105: 339–341.

  13. 13.

    Dazai Y, Katoh I, Sueda S, Katoh T, Yoshida R, Fujii M, et al. Report of a case of lung cancer with metastasis to the myocardium which showed electrocardiographic findings similar to acute myocardial infarction and intramyocardial mass on echocardiography.Kokyu To Junkan 1989; 37: 461–465.

  14. 14.

    Watanabe Y, Tanaka H, Kanayama H, Katou K. A case of lung cancer with myocardial metastasis with ECG suggestive of myocardial infarction.Nihon Kyobu Shikkan Gakkai Zasshi 1993; 31: 619–623.

  15. 15.

    Yao NS, Hsu YM, Liu JM, Chen LT, Liau CS. Lung cancer mimicking acute myocardial infarction on electrocardiogram.Am J Emerg Med 1999; 17: 86–88.

  16. 16.

    Berge T, Sievers J. Myocardial metastases. A pathological and electrocardiographic study.Br Heart J 1968; 30: 383–390.

  17. 17.

    Biran S, Hochman A, Levij IS, Stern S. Clinical diagnosis of secondary tumors of the heart and pericardium.Dis Chest 1969; 55: 202–208.

  18. 18.

    Gassman HS, Meadows R, Baker LA. Metastatic tumor of the heart.Am J Med 1955; 19: 357–365.

  19. 19.

    Eichstaedt HW, Felix R, Dougherty FC, Langer M, Rutsch W, Schmutzler H. Magnetic resonance imaging (MRI) in different stages of myocardial infarction using the contrast agent gadolinium-DTPA.Clin Cardiol 1986; 9: 527–535.

Download references

Author information

Correspondence to Shota Konishi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Konishi, S., Kojima, T., Ichiyanagi, K. et al. A case of double cancers with myocardial metastasis mimicking acute myocardial infarction both on an electrocardiogram and on Tc-99m-MIBI myocardial SPECT. Ann Nucl Med 15, 381 (2001).

Download citation

Key words

  • myocardial metastasis
  • AMI-like findings
  • ECG
  • Tc-99m-MIBI