Bronchogenic Carcinoma with Cardiac Invasion SimulatingAcute Myocardial Infarction

Cardiac metastases in bronchogenic carcinoma may occur due to retrograde lymphatic spread or by hematogenous dissemination oftumour cells, but direct invasion of heart by adjacent malignant lung mass is very uncommon. Pericardium is frequently involved indirect cardiac invasion by adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life threateningpresentation in such cases. But direct invasion of myocardium and endocardium is very uncommon. Left atrial endocardium ismost commonly involved in such cases due to anatomical contiguity with pulmonary hilum through pulmonary veins, and inmost cases left atrial involvement is asymptomatic. But myocardial compression and invasion by adjacent lung mass may resultin myocardial ischemia and may present with retrosternal, oppressive chest pain which clinically may simulate with the acutemyocardial infarction (AMI). As a result, it leads to misdiagnosis and delayed diagnosis of lung cancer. Here we report a case ofnon-small-cell carcinoma of right lung which was presented with asymptomatic invasion in left atrium and retrosternal chest painsimulating AMI due to myocardial compression by adjacent lung mass, in a seventy-four-year-old male smoker.