The role of MR imaging and cardio-pulmonary exercise test (CPET) in oncology patient : a case report

Abstract

Background: Thromboembolic complications are the second cause of mortality in patients with malignant neoplasms. Their course can be apparently asymptomatic, masked by other dominant symptoms of a malignant process. Therefore, there is a need for an unbiased diagnostic method to establish the causes of the patients' clinical condition. Case Report: The authors present a case of a 42-year-old neoplastic male patient admitted for bone marrow transplant. Examinations performed routinely before marrow transplantation showed pulmonary embolism in CT, while Trans Thoracic Echocardiography (TTE) revealed abnormal findings in the heart. Trans Esophageal Echocardiography (TEE) was indecisive and did not discriminate between a thrombus or neoplastic character of the observed pathological structures. MR helped to identify the findings as a thrombus. For unbiased initial assessment, the patient was referred for cardiopulmonary exercise test (CPET). Cardiopulmonary exercise test allowed to rule out any signs of restrictive or occlusive lung disease, and along with other diagnostic tests confirmed chronic thromboembolic pulmonary hypertension (CTEPH). Conclusions: Pulmonary embolism is found significantly more often in patients with neoplastic disease. Its course can be apparently asymptomatic, masked by other dominant symptoms of a malignant process. Magnetic resonance is a valuable tool in assessment of heart morphology, allowing proper diagnosis especially in thrombus identification, or detection of metastases. Cardiopulmonary exercise test can be useful in diagnosis and assessment of chronic thromboembolic pulmonary hypertension in apparently asymptomatic patients. CPET used in conjunction with MR seem to be a valuable combination capable of providing correct diagnosis where other methods fail