PMC7243387_01
Prior electrocardiogram (A), chest radiograph on admission (B), and computed tomography of the chest (C and D).. *denotes osseus involvement of the sternum; black arrows demonstrate extrinsic compression.
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An electrocardiogram performed on presentation revealed sinus tachycardia, ventricular bigeminy, low voltage in the extremity leads, and abnormal R-wave transition, which were new findings from an electrocardiogram on file from the year prior (Figure 1A). Chest radiograph revealed cardiomegaly, with mediastinal and hilar opacities of the left chest (Figure 1B). Computed tomography (CT) of the chest showed a disproportionately large left breast mass with left axillary metastatic disease, extensive pulmonary metastatic disease, mediastinal and hilar adenopathy, left internal mammary adenopathy, and osseous metastatic disease involving the sternum with encroachment on the right ventricle of the heart (Figure 1C and D).
Transthoracic echocardiogram demonstrating right ventricular outflow tract compression.
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Transthoracic echocardiogram was notable for a hyperdynamic ejection fraction of 70%, the presence of an anterior extracardiac structure causing compression of the right ventricular outflow tract (Figure 2) with an increased right ventricular outflow tract (RVOT) peak flow velocity of 150 cm/s, moderate dilation of the inferior vena cava with decreased inspiratory collapse, and elevated right ventricular systolic pressure of 52 mm Hg, with mild tricuspid regurgitation and mild pulmonic valve regurgitation.