PMC9827352_01
CT-scans showing cardiac metastasis at different time points during treatment: 1) before starting six cycles of chemotherapy, maximum diameter of 38 mm; 2) after two cycles of chemotherapy, maximum diameter of 30 mm; 3) after six cycles of chemotherapy, constant maximum diameter 30 mm; 4) two months after six cycles of chemotherapy, tumor mass filling two third of right ventricle.
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The CT scan of the chest and abdomen showed a tumor-specific mass in the right ventricle, hence a cardiac-CT was ordered, which confirmed the diagnosis of cardiac metastasis with infiltration of the pericardium (see Fig. 1). Therefore, we chose to continue with chemotherapy (see Fig. 1) and decided not to conduct endomyocardial biopsy of the cardiac mass to rule out another form of malignancy. Fig. 1). Finally, we discussed best supportive care and palliative treatment due to deteriorating health and progressive disease with poor prognosis of overall survival.
CT-scan demonstrating massive progress of metastatic disease two months after six cycles of chemotherapy: 1) enlargement of local bladder cancer, size of 78 mm x 100 mm x 81 mm; 2) multiple new bilateral pulmonary metastases, maximum diameter of 7 mm at left basal lower lobe; 3) osteolysis with soft tissue component of the right dorsal vertebral arch 7 with spread to epidural, size 18 mm x 24 mm; 4) live lesion subcapsular in segment VI.
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In addition to the increasingly infiltrating carcinoma of the urinary bladder, new bilateral pulmonary and osseous metastases and cancerous suspicious liver lesions were described (see Fig. 2).